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Strongly favor this test or intervention.

The International Staging System (ISS) for multiple myeloma evaluates disease severity and prognosis based on serum β2 microglobulin and serum albumin levels. Understanding and defining the stage is essential for determining appropriate treatment and estimating median survival.

Input parameters:
- Serum β2 microglobulin:
  - < 3.5 mg/L
  - 3.5-5.4 mg/L
  - > 5.4 mg/L
- Serum albumin:
  - < 3.5 g/dL
  - >= 3.5 g/dL

The process identifies the stage of multiple myeloma by checking these conditions:

1. **Stage I multiple myeloma:**
   - Occurs when serum β2 microglobulin is less than 3.5 mg/L and serum albumin is 3.5 g/dL or higher. This stage implies a generally favorable prognosis, with a median survival time of 62 months.

2. **Stage II multiple myeloma:**
   - Is diagnosed when serum β2 microglobulin is either less than 3.5 mg/L with serum albumin below 3.5 g/dL, or when serum β2 microglobulin falls between 3.5-5.4 mg/L, regardless of serum albumin levels. The median survival for Stage II is approximately 44 months, representing an intermediate prognosis.

3. **Stage III multiple myeloma:**
   - Is indicated if serum β2 microglobulin is greater than 5.4 mg/L, with this condition outweighing any serum albumin results. This stage suggests a more severe disease state, with a median survival of around 29 months.

By providing the specific serum protein measurements, clinicians and patients can determine the stage of multiple myeloma using these well-established ISS criteria. Each stage is linked with a particular survival timeframe, thus aiding in planning and managing treatment options effectively.

The International Staging System for Multiple Myeloma (ISS) is a prognostic tool used specifically for patients diagnosed with multiple myeloma, a type of blood cancer. The ISS is designed to predict the survival outcome of these patients based on two laboratory values: serum beta-2 microglobulin and serum albumin levels. The ISS stratifies patients into three stages, with higher stages indicating a poorer prognosis. This calculator is crucial in guiding treatment decisions and informing discussions about prognosis with patients. There are no specific exclusion criteria for its use, but it may be less accurate in patients with renal impairment as beta-2 microglobulin levels can be elevated in this condition.

International Staging System for multiple myeloma (ISS)

The Revised International Staging System (R-ISS) for multiple myeloma evaluates the prognosis of a patient using four specific clinical features: serum beta-2 microglobulin, serum albumin, chromosomal abnormalities by iFISH, and LDH levels. The outcomes are categorized into three distinct stages, each with a defined median progression-free survival time.

Each input is classified as follows: 

1. Serum beta-2 microglobulin:
   - < 3.5 mg/L
   - 3.5-5.4 mg/L
   - >= 5.5 mg/L
   
2. Serum albumin:
   - < 3.5 g/dL
   - >= 3.5 g/dL

3. Chromosomal abnormalities by iFISH:
   - No high-risk abnormality
   - High risk abnormality (e.g., del(17p), t(4;14), t(14;16))

4. LDH:
   - Normal
   - High

The computation process involves checking these conditions:

- If serum beta-2 microglobulin is less than 3.5 mg/L, serum albumin is 3.5 g/dL or higher, no high-risk chromosomal abnormalities are present, and LDH is normal, the median progression-free survival time is 66 months. This indicates the most favorable prognosis.

- If serum beta-2 microglobulin is 5.5 mg/L or higher, regardless of serum albumin levels, but with either high-risk chromosomal abnormalities and/or elevated LDH, the median progression-free survival time is 29 months. This represents the least favorable prognosis.

- If the conditions do not fit either of the above scenarios, the median progression-free survival time is estimated to be 42 months, reflecting an intermediate prognosis.

Each of these scenarios takes into account key biomarkers and genetic factors, aligning them into categories that describe the disease progression outlook. The computation checks these conditions in sequence to determine the median progression-free survival, making it crucial to fill in each field accurately to get a precise result. If any input is missing, the system defaults to requesting a complete set of selections.

The Revised International Staging System for Multiple Myeloma (R-ISS) is a prognostic scoring system used specifically for patients diagnosed with multiple myeloma. This calculator is designed to stratify patients into different risk groups based on various clinical and laboratory parameters, including serum albumin, beta-2 microglobulin, lactate dehydrogenase (LDH), and chromosomal abnormalities. The R-ISS is used to predict overall survival and progression-free survival, aiding clinicians in making informed decisions about treatment strategies and patient management. It is not applicable to patients with other types of cancer or those who lack the necessary laboratory data for calculation.

Revised international staging system for multiple myeloma (R-ISS)

The calculator aims to predict the prognosis for individuals with asymptomatic myeloma by assessing the risk of disease progression over five years. This is done using two key laboratory measurements: bone marrow plasmacytosis percentage and serum monoclonal protein levels. 

The user provides the following inputs:
- Bone marrow plasmacytosis percentage, which can be:
  - ">= 10%"
  - "< 10%"

- Serum monoclonal protein level, which can be:
  - ">= 3 g/dL"
  - "< 3 g/dL"

With these inputs, the calculator evaluates the following conditions to assess risk:

- When bone marrow plasmacytosis is "< 10%" and serum monoclonal protein is ">= 3 g/dL", the risk of myeloma progression at five years is 15%.
- When bone marrow plasmacytosis is ">= 10%" and serum monoclonal protein is "< 3 g/dL", there's a 43% risk of progression within five years.
- If both bone marrow plasmacytosis is ">= 10%" and serum monoclonal protein is ">= 3 g/dL", the risk rises to 69% at five years.
- If both parameters are below their respective thresholds (bone marrow plasmacytosis "< 10%" and serum monoclonal protein "< 3 g/dL"), the individual does not meet the criteria for asymptomatic myeloma.

This structured approach clearly identifies and communicates the percentage risk of myeloma progression over a five-year period, helping patients understand their prognosis based on these specific clinical measurements.

The calculator in question is the International Staging System (ISS) for Asymptomatic Myeloma Prognosis. This scoring system is used specifically for patients diagnosed with asymptomatic (smoldering) multiple myeloma, a type of blood cancer. The ISS for Asymptomatic Myeloma Prognosis helps clinicians to stratify patients into different risk groups based on their serum beta-2 microglobulin and albumin levels. This, in turn, aids in predicting the patient's overall survival and progression to symptomatic disease, thereby guiding treatment decisions. The calculator is not applicable to patients with symptomatic multiple myeloma or other types of blood cancers.

Asymptomatic myeloma prognosis

Multiple myeloma

Management of relapsed/refractory disease

Management of relapsed/refractory disease (assessment of response)

Management of relapsed/refractory disease, systemic therapy

Stem cell transplantation

Stem cell transplantation, conditioning

Maintenance therapy

Risk assessment

Management of treatment-related adverse events

Management of treatment-related adverse events (thrombosis)

Management of relapsed/refractory disease (general principles)

Assessment of treatment response

Assessment of treatment response (transplant ineligible)

General principles

Management of treatment-related adverse events (gastrointestinal disturbances)

Induction therapy

Induction therapy, transplant ineligible

Management of treatment-related adverse events (cytopenias)

Diagnostic imaging

Bone marrow examination

Stem cell transplantation, indications

Management of relapsed/refractory disease, stem cell transplantation

Management of relapsed/refractory disease (risk assessment)

Assessment of treatment response (transplant eligible)

Induction therapy, transplant eligible

Eligibility for hematopoietic stem cell transplantation

Eligibility for HSCT

Bone-modifying agents

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Renal biopsy

Bone-modifying agents (initiation)

Laboratory tests

Consolidation therapy

Frailty assessment

Management of treatment-related adverse events (fatigue)

Management of treatment-related adverse events (infections)

Management of treatment-related adverse events (neuropathy)

Multiple myeloma

Guidelines

Key sources