A novel risk stratification system appears to be highly predictive of prognosis among patients with newly diagnosed multiple myeloma (MM), according to a paper published in Blood Cancer Journal.

MM, a hematologic disease that is considered incurable, involves bone marrow infiltration and is characterized by organ involvement. While targeted treatments have improved outcomes among patients with MM over the past several decades, the disease generally takes a heterogenous course, with highly variable prognoses in patient populations.

The Revised International Staging System (R-ISS), which was implemented by the International Myeloma Working Group (IMWG), is a simple prognostic tool that has shown high predictive power since it was brought into use. There is, however, concern among some researchers that too many patients are allocated to R-ISS stage II, which accounts for more than half of all newly diagnosed patients. Other variables not accounted for in the R-ISS may, furthermore, affect patient outcomes.

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The IMWG recently recommended inclusion of computed tomography (CT), magnetic resonance imaging (MRI), and 18F-fluorodeoxyglucose positron emission tomography/CT (18F-FDG PET/CT) at diagnosis. For this study, researchers evaluated whether including imaging in a risk stratification system improves predictive power among newly diagnosed patients with MM.

In the cohort used for the risk stratification system’s design, data from 380 patients were included. The median age was 66 years (range, 34-86), 52.1% of patients were male sex, 77.4% of patients had an Eastern Cooperative Oncology Group performance status of 0 or 1, and 60.5% of patients had R-ISS stage II disease.

The combined scoring system, which included R-ISS criteria and PET/CT imaging data, had 4 possible risk groups:

  1. Stage I (R-ISS stage with 3 or fewer focal lesions; 31 patients)
  2. Stage II (R-ISS stage I with more than 3 focal lesions and R-ISS stage II with 3 or fewer focal lesions; 156 patients)
  3. Stage III (R-ISS stage II with more than 3 focal lesions and R-ISS stage III with 3 or fewer focal lesions; 162 patients)
  4. Stage IV (R-ISS stage III with more than 3 focal lesions; 31 patients)

Per the novel stratification system criteria, the 2-year overall survival (OS) rates for stages I, II, III, and IV were 96.7%, 89.8%, 74.7%, and 50.3%, respectively. 

In a validation cohort of 67 patients, the 2-year OS rates for stages I, II, and III per R-ISS criteria were 100%, 80.3%, and 61.3%, respectively (P =.037). Using the novel R-ISS/PET criteria, however, the 2-year OS rates in stages I, II, III, and IV were 100%, 89.9%, 82.6%, and 42.0%, respectively (P =.001).


Cho HJ, Jung SH, Jo JC, et al. Development of a new risk stratification system for patients with newly diagnosed multiple myeloma using R-ISS and 18F-FDG PET/CT. Blood Cancer J. 2021;11(12):190. doi:10.1038/s41408-021-00577-2