Impact of Revised International Staging System 2 Risk Stratification on Outcomes of Patients With Multiple Myeloma Receiving Autologous Haematopoietic Stem Cell Transplantation

Authors

Kamal Alzahrani
Oren Pasvolsky
Zhongya Wang
Denái R Milton
Mark R Tanner
Qaiser Bashir
Samer Srour
Neeraj Saini
Paul Lin
Jeremy Ramdial
Yago Nieto
Hans C Lee
Krina K Patel
Elisabet E Manasanch
Partow Kebriaei
Sheeba K Thomas
Donna M Weber
Robert Z Orlowski
Elizabeth J Shpall
Richard Champlin
Muzaffar H Qazilbash

Publication Date

5-1-2024

Journal

British Journal of Haematology

Abstract

The second revision of the International Staging System (R2-ISS) is a simple tool to risk-stratify newly diagnosed multiple myeloma (NDMM) patients. Here, we completed a retrospective analysis to evaluate the utility of R2-ISS in NDMM patients who underwent up-front autologous haematopoietic stem cell transplantation (auto-HCT). A total of 1291 patients were included, with a median age of 62 years (range 29-83). The distribution of R2-ISS stages was: 123 (10%) stage I, 471 (36%) stage II, 566 (44%) stage III and 131 (10%) stage IV. With a median follow-up of 42.2 months (range 0.3-181.0), the median PFS was 73.0, 65.2, 44.0 and 24.8 months, (p < 0.001) and the median OS was 130.8, 128.5, 94.2 and 61.4 months (p < 0.001) for patients with R2-ISS stages I, II, III and IV respectively. On multivariable analysis (MVA) for PFS, using R2-ISS stage I as reference, R2-ISS stages III (hazard ratio [95% confidence interval], 1.55 [1.05-2.29]; p = 0.028) and IV (2.04 [1.24-3.36]; p = 0.005) were associated with significantly inferior PFS. In the MVA of OS, using R2-ISS stage I as reference, only R2-ISS stage IV was associated with significantly inferior OS (2.43 [1.18-5.01]; p = 0.017). Overall, we found that R2-ISS is a reliable prognostic tool for NDMM patients undergoing up-front auto-HCT.

Keywords

Humans, Multiple Myeloma, Hematopoietic Stem Cell Transplantation, Middle Aged, Aged, Female, Male, Adult, Neoplasm Staging, Retrospective Studies, Transplantation, Autologous, Aged, 80 and over, Risk Assessment, Treatment Outcome, International Staging System, R2‐ISS, haematopoietic stem cell transplantation, multiple myeloma.

DOI

10.1111/bjh.19384

PMID

38448009

PMCID

PMC11090754

PubMedCentral® Posted Date

5-1-2025

PubMedCentral® Full Text Version

Author MSS

Published Open-Access

yes