Welcome to Managing Myeloma. My name is Dr. Paul Richardson and I am the clinical program leader and director of clinical research at the Jerome Lipper Multiple Myeloma Center at Dana-Farber Cancer Institute in Boston, Massachusetts. It is my pleasure to be with you today to discuss the so-called R-ISS, which is basically a Revised International Staging System designed to further assess risk. Now it is designed to improve our prognostication of newly diagnosed multiple myeloma patients and it does tell us some important new information. The most important is that it incorporates the impact of high-risk cytogenetics and at the same time LDH. And so what it means is that the traditional ISS stage I patient remains ISS stage I, as long as they have a normal LDH and they are without adverse cytogenetics, which in this case include del(17p), t(4;14) and t(14;16). Now in contrast, the stage III patients combine both ISS Stage III criteria with an elevated LDH and any of the three adverse cytogenetic findings, namely del(17p), t(4;14) or t(14;16). And ISS Stage II-R, as it is now called, is basically anything in between. I think why this is very useful is because it combines the importance of the ISS staging as classically defined, which I do think in my own practice is important, but at the same time it gives us a rational structure around how to incorporate the impact of the high LDH, which we know is an adverse feature as well as the most important FISH-based adverse cytogenetics.
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Reviewed on January 17, 2017 for clinical relevance.