Is the international staging system superior to the Durie–Salmon staging system? A comparison in multiple myeloma patients undergoing autologous transplant
Open accessAbstract
The international staging system (ISS) for multiple myeloma (MM) is a validated alternative to the Durie–Salmon staging system (DSS) for predicting survival at diagnosis. We compared these staging systems for predicting outcomes after upfront autologous stem cell transplantation by analyzing the outcomes of 729 patients between 1995 and 2002. With a median follow-up of 56 months, the univariate probabilities (95% CI) of non-relapse mortality (NRM), relapse, progression-free survival (PFS) and overall survival (OS) at 5 years were 7, 68, 25 and 52%, respectively. The median OS for stages I, II, III by DSS and ISS were 82, 68, 50 and 64, 68, 45 months, respectively. The concordance between the two staging systems was only 36%. Staging systems were formally compared using Cox models fit with DSS and ISS stages. The relative risks of PFS and OS were significantly different for stages I vs II and II vs III for DSS, but only for stages II vs III for ISS. Although both systems were predictive of PFS and OS, the DSS was superior in formal statistical comparison using Brier score. However, neither system was strongly predictive of outcomes, indicating the need for newer schemes incorporating other prognostic markers.
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Both the ISS and DSS systems assess tumor burden, but neither takes into consideration the biology of the disease, which determines overall survival.
“Both the ISS and DSS systems assess the tumor burden, but neither ISS nor DSS takes into consideration the biology of the disease, which determines the overall survival [20,21,22].”
From Epidemiology, Staging, and Management of Multiple Myeloma (2021) · cites this paper as [22]
The Introduction and Discussion (page unavailable) describe DSS as tracking tumor mass and ISS as partly reflecting disease burden; they also say biological markers predict outcomes independently of clinical stage. But the paper does not establish that neither system captures disease biology: it says whether higher ISS stages reflect myeloma aggressiveness is unclear. It also treats host and treatment-related factors as relevant to survival, so the claim that biology determines overall survival is too categorical. (LLM, conf=0.84)
Experimental — accuracy not yet measuredTumor burden in multiple myeloma has traditionally been measured with the Durie-Salmon Staging and the International Staging System.
“Tumor burden in multiple myeloma has traditionally been assessed using the Durie-Salmon Staging (DSS)51 and the International Staging System (ISS).52,53”
From Multiple myeloma: 2024 update on diagnosis, risk-stratification, and management (2024) · cites this paper as [53]
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References 27 · Cited by 100
- Authors
- Hari, P. N., Zhang, M.-J., Roy, V, Pérez, W. S., Bashey, A., To, L. B., Elfenbein, G., Freytes, C. O., Gale, R. P., Gibson, J., Kyle, R. A., Lazarus, H. M., McCarthy, P. L., Milone, G. A., Pavlovsky, S., Reece, D. E., Schiller, G., Vela-Ojeda, J., Weisdorf, D., & Vesole, D.
- Affiliations
- Medical College of Wisconsin (US)
- Mayo Clinic in Florida (US)
- South Australia Pathology (AU)
- Boston University (US)
- The University of Texas at San Antonio Health Science Center (US)
- Celgene (United States) (US)
- Royal Prince Alfred Hospital (AU)
- Mayo Clinic (US)
- University Hospitals Cleveland Medical Center (US)
- Roswell Park Comprehensive Cancer Center (US)
- Princess Margaret Cancer Centre (CA)
- University of California, Los Angeles (US)
- University of Minnesota Medical Center (US)
- Loyola University Medical Center (US)
- Corresponding author
- Hari, P N
- ORCID
- Venue
- Leukemia
- Published
- 2009-03-26
- Volume
- 23
- Issue
- 8
- Pages
- 1528-1534
- ISSN
- 0887-6924 (ISSN-L)
- 1476-5551
- PMC
- PMC2726276
- OpenAlex
- W2159528874
- Semantic Scholar
- 0514f593a6ea94a3355e7bdb919941151d9b8943
- Cited by
- 100
- References
- 27
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 3 · 2023: 10 · 2022: 12 · 2021: 7 · 2020: 10 · 2019: 4 · 2018: 7 · 2017: 5 · 2016: 8 · 2015: 3 · 2014: 4 · 2013: 8 · 2012: 4
- FWCI
- 3.33
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Leukemia (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
- Funders
- National Cancer Institute (U24CA076518)
- Topics
- Health Sciences › Medicine › Hematology › Multiple Myeloma Research and Treatments
- Health Sciences › Medicine › Pathology and Forensic Medicine › Multiple Sclerosis Research Studies
- Health Sciences › Medicine › Pathology and Forensic Medicine › Lymphoma Diagnosis and Treatment
- Keywords
- multiple myeloma, International Staging System, autologous stem cell transplantation, prognostic staging, progression-free survival, overall survival, non-relapse mortality, prognostic factors
- MeSH terms
- Adult, Aged, Female, Follow-Up Studies, Humans, Male, Middle Aged, Multiple Myeloma, Neoplasm Staging, Predictive Value of Tests, Retrospective Studies, Transplantation, Autologous, Proportional Hazards Models, Treatment Outcome, Hematopoietic Stem Cell Transplantation, Disease Progression, Disease-Free Survival, Transplantation Conditioning, Kaplan-Meier Estimate
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