Validation of International Staging System (ISS) for Multiple Myeloma: A Retrospective Analysis of 487 Patients at 8 Brazilian Centers.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 5069-5069
Author(s):  
Vania T.M. Hungria ◽  
Angelo Maiolino ◽  
Gracia Martinez ◽  
Gisele Colleoni ◽  
Luciana Oliveira ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Prognostic Factors ◽  
Median Survival ◽  
Staging System ◽  
Stage I ◽  
Stage Ii ◽  
Stage Iii ◽  
High Dose ◽  
International Staging System ◽  
New System

Abstract Introduction: The survival of patients with multiple myeloma varies from a few months to more than 10 years. This heterogeneity is related to the characteristics of the myeloma itself and of the host. The identification of the factors which influence the prognosis is very important to predict the result, assist in the choice of the treatment and adequately stratify the patients in clinical studies. Many prognostic factors have been identified in patients with multiple myeloma, such as anemia, renal failure, ß2 microglobulin, albumin and chromossomic alterations. Some authors have combined prognostic factors and proposed various systems of staging. However, none of them have yet substituted the Durie-Salmon staging system. Recently, the International Myeloma Working Group, with the objective of developing a simple and reliable staging system, which can be internationally applied to classify and stratify patients with multiple myeloma, identified 3 risk groups. This new system of staging, the “International Staging System” (ISS), consists of stage I: ß2 microglobulin < 3.5 mg/L plus albumin ≥ 3.5 g/dL (median survival: 62 months); stage II: neither I nor III (median 44 months); stage III: ß2 microglobulin > 5.5 mg/L (median 29 months). This study included sites in North America, Europe and Asia, but the sites in Latin America were not included. Objective: To validate the ISS in patients with multiple myeloma at Brazilian centers. Patients and Methods: Four hundred and eighty-seven patients with the diagnosis of multiple myeloma within the period of 1998 to 2004 at Santa Casa de São Paulo, Hospital Universitário Clementino Fraga Filho do Rio de Janeiro, Hospital das Clínicas de São Paulo, Hospital São Paulo, Hospital das Clínicas de Ribeirão Preto, HEMOPE, Hospital Prof. Edgar Santos de Salvador and Hospital de Clínicas de Porto Alegre, with available data on albumin and ß2 microglobulin, were stratified according to the ISS. A total of 339 patients received standard therapy and 148 received high-dose therapy as initial therapy. The survival was estimated using the Kaplan-Meier method with differences in survival examined using the logrank test. Results: The median age of the patients was 60 years, 52% male and 48% female. In Stage I (n=104), the global median survival was not reached, the survival at 60 months was 60%, in stage II (n=264), the global median survival was 61 months and in stage III (n=119), 19 months (p<0.001). Conclusion: The new system of staging for multiple myeloma (ISS) is simple, based on variables easy to be applied and was possible to be validated in patients with multiple myeloma in Brazilian centers.

scholarly journals The Role of18F-FDG PET/CT in Multiple Myeloma Staging according to IMPeTUs: Comparison of the Durie–Salmon Plus and Other Staging Systems

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Shengming Deng ◽  
Bin Zhang ◽  
Yeye Zhou ◽  
Xin Xu ◽  
Jihui Li ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Bone Marrow ◽  
Prognostic Factors ◽  
Staging System ◽  
Stage I ◽  
Stage Ii ◽  
Stage Iii ◽  
Newly Diagnosed ◽  
Deauville Score ◽  
Staging Systems

We aimed at comparing the Durie–Salmon Plus (DS Plus) staging system based on Italian Myeloma criteria for PET USe (IMPeTUs) with other two staging systems in predicting prognosis of patients with all stages of newly diagnosed multiple myeloma (MM). A total of 33 MM patients were enrolled in this retrospective study. The variation between the DS Plus classification and Durie–Salmon staging system (DSS) or Revised International Staging System (RISS) classification was assessed. When staged by the DSS, patients in stage I and stage II did not reach the median overall survival (OS), and the median OS was 33 months for stage III (p=0.3621). When staged by the DS Plus, patients in stage I did not reach the median OS of stage I, and the median OS for stages II and III was 38 and nine months, respectively (p=0.0064). When staged by the RISS, patients in stage I did not reach the median OS, and the median OS was 33 and 16 months for stage II and stage III, respectively (p=0.0319). The concordances between two staging systems were 0.07 (DS Plus versus DSS) and 0.37 (DS Plus versus RISS), respectively. Multivariate analysis revealed that DS Plus stage III (HR: 11.539,p=0.021) and the Deauville score of bone marrow ≥4 (HR: 3.487,p=0.031) were independent prognostic factors associated with OS. Both the DS Plus based on IMPeTUs and RISS possessed a better potential in characterizing and stratifying MM patients compared with the DSS. Moreover, DS Plus stage III and the Deauville score of bone marrow ≥4 were reliable prognostic factors in newly diagnosed MM patients.

Exchange of International Staging System for Durie&Salmon Staging System in Therapeutic Strategy for Multiple Myeloma.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 5167-5167
Author(s):  
Shingo Kurahashi ◽  
Hiroto Narimatsu ◽  
Takumi Sugimoto ◽  
Isamu Sugiura
Keyword(s):  
Multiple Myeloma ◽  
Overall Survival ◽  
Clinical Outcome ◽  
Therapeutic Strategy ◽  
Staging System ◽  
Stage I ◽  
Stage Ii ◽  
Clinical Staging ◽  
Secondary Malignancy ◽  
International Staging System

Abstract Introduction: Since multiple myeloma (MM) is not a curative disease and clinical outcome is variable, chemotherapy is started only when patients developed organ impairment or progression of disease. As for clinical staging, Durie&Salmon (DS) system is in use. The International Staging System (ISS) for MM has been recently reported to provide simple and useful prognostic grouping (Greipp et al. 2005). However, its usefulness in therapeutic strategy has not been clearly demonstrated. Patients and methods: We reviewed medical records of patients with MM, newly diagnosed in Toyohashi Municipal Hospital between May 1997 and April 2004. They were all stratified based on both ISS and DS system. Results: The median age of 55 patients was 67 years (range; 46–86). M protein isotypes included IgG (n=33), IgA (n=13), BJP (n=6) and IgD (n=1). Fifty-two patients were treated with chemotherapy and 12 of those patients underwent autologous peripheral blood stem cell transplantation. The median follow-up of the patients was 26.8 months (range; 1.4–77.5). Their staging and overall survival (OS) are summarized on the following table. ISS predicted OS more clearly than DS system in our study. Overall survival based on ISS and DS system ISS DS stage no. of patients OS at 3 yrs no. of patients OS at 3 yrs I 14 1.00 3 0.67 II 22 0.55 20 0.79 III 19 0.25 32 0.40 p-value 0.0102 0.3287 Thirteen of the 14 patients with ISS stage I are alive at median months of 31.5 (10.4–73.8), and only one patient died of secondary malignancy at 44.9 months from diagnosis. The patients with ISS stage I included 86% of DS stage II and III patients, who are usually required treatment. Conclusions and discussions: ISS could predict clinical outcome more clearly than DS system. The patients’ prognosis was good in ISS stage I although many patients with DS stage II and III was included in this group. We suggests that early treatment to the patients with ISS stage I might not be necessarily required. Further studies are needed to adopt ISS instead of DS system in therapeutic strategy. Figure Figure

scholarly journals Dynamic Changes in International Staging System As a Predictor of Survival Outcome in Patients with Advanced Multiple Myeloma

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 4438-4438
Author(s):  
Jin-Liern Hong ◽  
Victoria Crossland ◽  
Aaron Galaznik ◽  
Paul Dolin
Keyword(s):  
Multiple Myeloma ◽  
Mortality Rate ◽  
Staging System ◽  
Stage I ◽  
Stage Ii ◽  
Stage Iii ◽  
Study Cohort ◽  
Dynamic Changes ◽  
Beta 2 Microglobulin ◽  
Line Of Therapy

Abstract Background: The International Staging System (ISS) based on serum beta-2 microglobulin and serum albumin is a useful tool for risk stratification in patients with multiple myeloma. ISS is usually assessed at the time of diagnosis. Recent studies have suggested that risk stratification should be considered dynamic over the disease course. Our study aimed to describe dynamic changes in ISS over time and their impacts on mortality in patients with advanced multiple myeloma. Methods: This study included 417 patients with multiple myeloma from the Flatiron medical records database (Jan 2011- May 2018) who have received at least two lines of therapy and had data on ISS at the time of diagnosis (TDX) and at the time of initiating the second line of therapy (T2L). ISS stage was either abstracted from medical records or derived from the results of laboratory tests of serum beta-2 microglobulin and serum albumin. Patients were followed up from T2L until the earliest event of the last activity in database or death. We calculated mortality rates by TDX and T2L ISS stages, and generated Cox proportional hazard models to estimate the impact of TDX and T2L ISS stages on mortality. Additionally, in the subgroup of patients in ISS stage III at TDX, we used univariate logistic models to identify the predictors for downward shift to ISS stage I or II at T2L. Results: The study cohort had a median age of 70 (interquartile range: 61 to 77), and 59% were male. Based on ISS at TDX, 30%, 37%, and 33% of the study cohort were classified as stage I, II, and III with the mortality rate of 12, 11, and 24 deaths per 100 person-years, respectively. The hazard ratios were 0.95 (95% confidence interval (CI): 0.57-1.61) for patients in stage II and 1.96 (95% CI: 1.22-3.16) for patients in stage III, compared with patients in stage I. Based on ISS at T2L, 47%, 34%, and 20% were classified as stage I, II, and III, with the mortality rate of 7, 19, and 39 deaths per 100 person-years, respectively. The hazard ratios were 2.62 (95% CI: 1.61-4.25) for patients in stage II and 5.18 (95% CI: 3.10-8.64) for patients in stage III, compared with patients in stage I. Dynamic changes in ISS stages over time and mortality rates were depicted in the Table. Among patients in ISS stage I at TDX, about 25% shifted to higher stages at T2L, and had a higher mortality rate (26 per 100 person-years) than did patients remaining in stage I (8 per 100 person-years). For patients in ISS stage II at TDX, 43% stayed in Stage II at T2L, and 46% moved down to Stage I, with a mortality rate of 20 and 5 per 100 person-years, respectively. Among patients in ISS stage III at TDX, 58% moved down to lower stages at T2L. The mortality rate was 10, 21, and 40 per 100 person-years for patients moving down to Stage I and II at T2L and those remaining in Stage III, respectively. In the subgroup of patients in ISS stage III at TDX, strong predictors for shifting down to lower stages were younger age (odds ratio: 2.65; 95% CI:1.20-5.87 for age <65 vs ≥65 years) and serum creatinine ≤ 2 mg/dL at TDX (odds ratio: 2.26; 95% CI:1.03-4.92 for serum creatinine ≤ 2 vs >2 mg/dL), but not gender, race, or cytogenetic abnormality of del17p, t(4;14), and t(14;16). Conclusion: Large changes in ISS stages were observed in multiple myeloma patients when advancing the line of therapy. Changes in ISS stage were also associated with survival outcome. A downward shift to stage I was associated with substantially improved overall survival; in contrast, patients moving up to or remaining in higher stages had poor outcomes, especially for those remaining in ISS stage III. Our results suggest that re-evaluating ISS stage at the time of change in line of therapy can improve prediction of survival outcomes. Disclosures Hong: Takeda Pharmaceuticals International Co.: Employment. Crossland:Takeda Pharmaceuticals International Co.: Employment. Galaznik:Takeda Pharmaceuticals International Co.: Employment. Dolin:Shire: Other: PD holds shares in Shire ; GSK: Other: PD holds shares in GSK; Takeda Pharmaceuticals International Co.: Employment.

International Staging System for Multiple Myeloma

2005 ◽  
Vol 23 (15) ◽  
pp. 3412-3420 ◽  
Author(s):  
Philip R. Greipp ◽  
Jesus San Miguel ◽  
Brian G.M. Durie ◽  
John J. Crowley ◽  
Bart Barlogie ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
North America ◽  
Serum Albumin ◽  
Median Survival ◽  
Laboratory Data ◽  
Staging System ◽  
Stage I ◽  
Multivariate Techniques ◽  
Tree Survival ◽  
International Staging System

Purpose There is a need for a simple, reliable staging system for multiple myeloma that can be applied internationally for patient classification and stratification. Patients and Methods Clinical and laboratory data were gathered on 10,750 previously untreated symptomatic myeloma patients from 17 institutions, including sites in North America, Europe, and Asia. Potential prognostic factors were evaluated by univariate and multivariate techniques. Three modeling approaches were then explored to develop a staging system including two nontree and one tree survival assessment methodologies. Results Serum beta2-microglobulin (Sβ2M), serum albumin, platelet count, serum creatinine, and age emerged as powerful predictors of survival and were then used in the tree analysis approach. A combination of Sβ2M and serum albumin provided the simplest, most powerful and reproducible three-stage classification. This new International Staging System (ISS) was validated in the remaining patients and consists of the following stages: stage I, Sβ2M less than 3.5 mg/L plus serum albumin ≥ 3.5 g/dL (median survival, 62 months); stage II, neither stage I nor III (median survival, 44 months); and stage III, Sβ2M ≥ 5.5 mg/L (median survival, 29 months). The ISS system was further validated by demonstrating effectiveness in patients in North America, Europe, and Asia; in patients less than and ≥ 65 years of age; in patients with standard therapy or autotransplantation; and in comparison with the Durie/Salmon staging system. Conclusion The new ISS is simple, based on easy to use variables (Sβ2M and serum albumin), and recommended for early adoption and widespread use.

scholarly journals The Association of International Staging System (ISS) Stage with Disease and Symptom Burden in Patients with Newly Diagnosed Multiple Myeloma

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 2115-2115
Author(s):  
Mark A Fiala ◽  
Michael Slade ◽  
Jesse Keller ◽  
Keith Stockerl-Goldstein ◽  
Michael Tomasson ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Plasma Cells ◽  
Performance Status ◽  
Symptom Burden ◽  
Staging System ◽  
Stage I ◽  
Stage Iii ◽  
Newly Diagnosed ◽  
Bone Marrow Plasma ◽  
International Staging System

Abstract Background: The clinical presentation of multiple myeloma (MM) varies greatly but often includes bone pain, anemia, renal dysfunction, hypercalcaemia, and/or constitutional symptoms. There are no signs or symptoms that are disease specific. The earliest staging system for MM, the Durie-Salmon (DS), associated disease and symptom burden with prognosis; however, it has been largely replaced by the International Staging System (ISS), which is easier to compute and better identifies patients with the poorest prognosis. It is unclear if ISS stage, like DS, is associated with disease or symptom burden. Objective: To compare disease and symptom burden of patients with newly diagnosed MM by ISS Stage. Methods: Data was extracted from the open-access Multiple Myeloma Research Foundation (MMRF) Researcher Gateway corresponding with interim analysis 6 from the CoMMpass study. The CoMMpass study is enrolling 1000 newly diagnosed MM patients who will be tracked longitudinally for 5 years. CoMMpass collects relevant clinical data and patient reported quality of life (EORTC QLQ-C30 and QLQ-MY20), as well as sequential tissue samples. Eligibility requirements for CoMMpass include: symptomatic MM with measureable disease by SPEP (≥1.0g/dL), UPEP (≥200mg/24 hours), or SFLC (≥10mg/dL); receiving an immunomodulator and/or a proteasome inhibitor for initial MM treatment; and no prior malignancies in the past 5 years. All clinical data was reported by trained data analysts at the enrolling center with the exception of flow cytometry which was performed centrally; raw lab values for beta-2 microglobulin and albumin were entered and stage was subsequently calculated by the analysts for this study according to the ISS (Greipp et al, JCO 2005). Twenty-six patients with unknown ISS were excluded from the analysis. Data was analyzed using SPSS 21. Categorical variables were compared using χ2, continuous with one-way ANOVA tests. Results: 599 patients were eligible for analysis. Sex, race, and heavy and light chain isotypes were all evenly distributed among the ISS stages; however, median age for ISS stage III was 67, 65 for stage II and 62 for stage I (p<0.001). Stage I and II patients were similar in disease burden, but stage III patients had higher serum M-proteins (p<0.001), LDH (p=0.002), bone marrow plasma cells (p<0.001), circulating plasma cells (p<0.001), and creatinine (p<0.001), and lower hemoglobin (p<0.001) and platelets (p=0.001). Further, stage III patients had poorer performance status (p<0.001), global health (p<0.001), physical functioning (p<0.001), social functioning (p<0.001), and role functioning (p<0.001), and increased fatigue (p<0.001) and pain (p=0.016). Results are summarized in Table 1. Conclusions: Stage III had a higher disease and symptom burden than stage I and II patients. Stage I and II patients were similar in most measures suggesting that ISS may not discriminate between these groups well, this is supported by other studies that have failed to find outcomes differences between stage I and II patients. Table 1. Stage I n= 204 Stage II n = 210 Stage IIIn = 185 p Demographics Age in years 62 65 67 <0.001 Male 64% 57% 62% NS Race NS White 80% 83% 74% Black 19% 13% 23% Other 2% 3% 3% Heavy Chain NS IgG 80% 80% 75% IgA 20% 20% 25% Light Chain NS Kappa 65% 61% 60% Lambda 34% 38% 38% Biclonal 1% 2% 2% Disease Burden Serum M-Protein g/dL 1.9 2.0 3.2 <0.001 LDH μkat/L 2.7 2.8 3.0 0.002 Bone Marrow Plasma Cells* 7% 9% 13% <0.001 Circulating Plasma Cells* 0% 0% 0.1% <0.001 Calcium mmol/L 2.4 2.3 2.4 <0.001 Creatinine μmol/L 82 88 149 <0.001 Hgb mmol/L 7.4 6.4 5.8 <0.001 Platelets x109/L 222 212 199 .001 Bone Lesions 61% 52% 53% NS Symptom Burden/Quality of Life Measures ECOG Performance Status <0.001 0 47% 42% 22% 1 49% 42% 54% 2 5% 8% 15% 3-4 0% 8% 9% Global Health Scale 66 66 50 <0.001 Physical Functioning Scale 86 80 63 <0.001 Cognitive Functioning Scale 83 83 83 NS Emotional Functioning Scale 75 75 75 NS Social Functioning Scale 83 83 66 <0.001 Role Functioning Scale 66 66 50 <0.001 Disease Symptom Scale 27 22 27 NS Fatigue Scale 33 33 44 <0.001 Pain Scale 33 33 42 0.016 Note-Median presented unless specified. *- CD38+/CD138+ by flow cytometry Disclosures Vij: Takeda, Onyx: Research Funding; Celgene, Onyx, Takeda, Novartis, BMS, Sanofi, Janssen, Merck: Consultancy.

A Revised International Staging System of Multiple Myeloma in the Era of Novel Agents and Autologous Stem Cell Transplantation in Japan: A Multicenter Retrospective Collaborative Study of the Japanese Society of Myeloma

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 4199-4199
Author(s):  
Shuji Ozaki ◽  
Takayuki Saitoh ◽  
Hiroshi Handa ◽  
Hirokazu Murakami ◽  
Kenshi Suzuki ◽  
...  
Keyword(s):  
Risk Factors ◽  
Staging System ◽  
Stage I ◽  
Stage Ii ◽  
Novel Agents ◽  
Stage Iii ◽  
Conventional Chemotherapy ◽  
Related Risk ◽  
Significant Difference ◽  
International Staging System

Abstract Survival outcomes of patients with multiple myeloma (MM) vary considerably depending on the presence or absence of disease-related risk factors [i.e., advanced ISS (International Staging System) stage, CAs (cytogenetic abnormalities), etc.], patient-related risk factors, and/or treatment-related risk factors. ISS, developed in 2006 by the IMWG (International Myeloma Working Group), has been considered an important disease-related baseline prognostication model and has been used in routine clinical practice worldwide. However, it is solely determined by the serum biochemistry data without taking account of CAs which are currently identified as the most powerful prognostic indicator for MM. Recently, a Revised ISS (R-ISS) scoring system which is accounting the presence or absence of serum LDH abnormality as well as CAs such as t(4;14), t(14;16), or del(17p) in addition to the ISS stage has been proposed (Oliva S, et al. EHA 2014, #S1289). In the present study, we applied the R-ISS to the Japanese MM patients diagnosed between 2001 and 2012 and compared the clinical relevance of the R-ISS with that of the original ISS in the era of novel agents and autologous stem cell transplantation (ASCT). Clinical data of 3,270 patients were collected from 38 centers; however, ISS and R-ISS were only applicable to 2,998 and 788 patients, respectively. Patient characteristics including age, gender, type of M protein, Durie and Salmon stage, ISS stage, and chromosomal abnormalities were not significantly different between the patients to which ISS and R-ISS were applied. In the 788 patients evaluable for the R-ISS analysis, distribution of the patients according to the ISS stages I, II, and III were 31.4%, 35.8%, and 32.8%, respectively, whereas that of the R-ISS stages were 22.2%, 67.6%, and 10.2%, respectively. Median overall survival (OS) for the ISS stages I, II, and III were 100.7, 65.2, and 50.9 months, respectively, and that of R-ISS stages I, II, and III were 152.8, 62.4, and 40.5 months, respectively. Accordingly, the difference of survival time between the stages seemed more distinct in R-ISS compared with the performance of the original ISS. According to the analysis by the ISS, there were no significant difference in the median OS between the patients whether initially treated with novel agents or with conventional chemotherapy (stage I, 91.2 vs 84.6 months, p=0.054; stage II, 64.1 vs 62.5 months, p=0.18; and stage III, 41.2 vs 37.2 months, p=0.24). In contrast, the analysis by the R-ISS disclosed a beneficial effect of novel therapy than with conventional chemotherapy, particularly in patients with stage I disease (stage I, not reached vs 87.6 months, p=0.018; stage II, 78.8 vs 61.7 months, p=0.075; and stage III, 37.5 vs 45.3 months, p=0.87). As for ASCT, both ISS and R-ISS stages showed a significant difference in the median OS between the patients treated with ASCT and those without ASCT (ISS stages: stage I, 101.3 vs 78.8 months, p=0.40; stage II, 83.8 vs 52.4 months, p=0.0002; stage III, 67.5 vs 31.7 months, p=0.0004; and R-ISS stages: stage I, not reached vs 90.7 months, p=0.21; stage II, 74.2 vs 56.5 months, p<0.00001; stage III, 73.8 vs 37.5 months, p=0.11). Thus, our results have demonstrated that R-ISS is a useful model for the risk assessment of Japanese patients with MM. Notably, the outcome of MM patients with R-ISS stage I showed a dramatic improvement by the initial treatment with novel agents and ASCT. However, the survival benefit remained unmet in patients with advanced stages of R-ISS even in the era of novel agents and ASCT, and further development of therapeutic strategies is needed in high-risk patients with MM. Disclosures Sunami: Takeda pharmaceutical Compani Limited: Research Funding; ONO PHAMACEUTICAL CO.,LTD: Research Funding.

Cardiac transthyretin wild-type amyloidosis (ATTRwt): a prospective study of 400 patients followed at the Italian referral center

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Milani ◽  
L Obici ◽  
R Mussinelli ◽  
M Basset ◽  
G Manfrinato ◽  
...  
Keyword(s):  
Natural History ◽  
Median Survival ◽  
Troponin I ◽  
Stage I ◽  
Stage Ii ◽  
Stage Iii ◽  
Wild Type ◽  
Staging Systems ◽  
Significant Difference ◽  
History Of

Abstract Background Cardiac wild type transthyretin (ATTRwt) amyloidosis, formerly known as senile systemic amyloidosis, is an increasingly recognized, progressive, and fatal cardiomyopathy. Two biomarkers staging systems were proposed based on NT-proBNP (in both cases) and troponin or estimated glomerular filtration rate, that are able to predict survival in this population. The availability of novel effective treatments requires large studies to describe the natural history of the disease in different populations. Objective To describe the natural history of the disease in a large, prospective, national series. Methods Starting in 2007, we protocolized data collection in all the patients diagnosed at our center (n=400 up to 7/2019). Results The referrals to our center increased over time: 5 cases (1%) between 2007–2009, 33 (9%) in 2010–2012, 90 (22%) in 2013–2015 and 272 (68%) in 2016–2019. Median age was 76 years [interquartile range (IQR): 71–80 years] and 372 patients (93%) were males. One hundred and seventy-three (43%) had atrial fibrillation, 63 (15%) had a history of ischemic cardiomyopathy and 64 (15%) underwent pacemaker or ICD implantation. NYHA class was I in 58 subjects (16%), II in 225 (63%) and III in 74 (21%). Median NT-proBNP was 3064 ng/L (IQR: 1817–5579 ng/L), troponin I 0.096 ng/mL (IQR: 0.063–0.158 ng/mL), eGFR 62 mL/min (IQR: 50–78 mL/min). Median IVS was 17 mm (IQR: 15–19 mm), PW 16 mm (IQR: 14–18 mm) and EF 53% (IQR: 45–57%). One-hundred and forty-eight subjects (37%) had a concomitant monoclonal component in serum and/or urine and/or an abnormal free light chain ratio. In these patients, the diagnosis was confirmed by immunoelectron microscopy or mass spectrometry. In 252 (63%) the diagnosis was based on bone scintigraphy. DNA analysis for amyloidogenic mutations in transthyretin and apolipoprotein A-I genes was negative in all subjects. The median survival of the whole cohort was 59 months. The Mayo Clinic staging based on NT-proBNP (cutoff: 3000 ng/L) and troponin I (cutoff: 0.1 ng/mL) discriminated 3 different groups [stage I: 131 (35%), stage II: 123 (32%) and stage III: 127 (33%)] with different survival between stage I and II (median 86 vs. 81 months, P=0.04) and between stage II and III (median 81 vs. 62 months, P&lt;0.001). The UK staging system (NT-proBNP 3000 ng/L and eGFR 45 mL/min), discriminated three groups [stage I: 170 (45%), stage II: 165 (43%) and stage III: 45 (12%)] with a significant difference in survival: between stage I and stage II (86 vs. 52 months, P&lt;0.001) and between stage II and stage III (median survival 52 vs. 33 months, P=0.045). Conclusions This is one of the largest series of patients with cardiac ATTRwt reported so far. Referrals and diagnoses increased exponentially in recent years, One-third of patients has a concomitant monoclonal gammopathy and needed tissue typing. Both the current staging systems offered good discrimination of staging and were validated in our independent cohort. Funding Acknowledgement Type of funding source: None

Clinical Staging for Sleep-Disordered Breathing

2002 ◽  
Vol 127 (1) ◽  
pp. 13-21 ◽  
Author(s):  
Michael Friedman ◽  
Hani Ibrahim ◽  
Lee Bass
Keyword(s):  
Body Mass Index ◽  
Success Rate ◽  
Body Mass ◽  
Sleep Disordered Breathing ◽  
Staging System ◽  
Stage I ◽  
Stage Ii ◽  
Stage Iii ◽  
Clinical Staging ◽  
Disordered Breathing

OBJECTIVE: The purpose of this study was to identify prognostic indicators that would lead to stratification of patients likely to have successful surgery for sleep-disordered breathing (SDB) versus those destined to fail. STUDY DESIGN: We retrospectively reviewed 134 patients to correlate palate position and tonsil size to the success of the UPPP as based on postoperative polysomnography results. Similar to our previously published data on the Friedman Score as a predictor of the presence and severity of SDB, the palate position was determined on physical examination of the oral cavity and was graded for each patient. This grade combined with tonsil size was used to stage the patients. Stage I was defined as having palate position 1 or 2 combined with tonsil size 3 or 4. Stage II was defined as having palate position 3 or 4 and tonsil size 3 or 4. Stage III patients had palate position 3 or 4 and tonsil size 0, 1, or 2. Any patient with body mass index of greater than 40 was placed in the stage III group. The results of uvulopalatopharyngoplasty (UPPP) were then graded as success or failure and success rates were compared by stage. SETTING: Academically affiliated tertiary care referral center. RESULTS: Stage I patients who underwent UPPP had a success rate of 80.6%, stage II patients had a success rate of 37.9%, and stage III patients had a success rate of 8.1%. CONCLUSION: A clinical staging system for SDB based on palate position, tonsil size, and body mass index is presented. It appears to be a valuable predictor of the success of UPPP. Additional studies and wider use of the staging system will ultimately define its role in the treatment of SDB.

scholarly journals Early mortality in elderly patients undergoing treatment for multiple myeloma in real-world practice

2018 ◽  
Vol 46 (6) ◽  
pp. 2230-2237
Author(s):  
Jun Xia ◽  
Lingling Wang ◽  
Xin Zhou ◽  
Jing Wang ◽  
Huan Wang ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Lactate Dehydrogenase ◽  
Elderly Patients ◽  
Real World ◽  
Staging System ◽  
Early Mortality ◽  
Stage Iii ◽  
Newly Diagnosed ◽  
International Staging System ◽  
High Lactate

Objectives This study was performed to analyze the risk factors for early mortality (EM) in elderly patients undergoing treatment for multiple myeloma (MM) in real-world clinical practice. Methods Retrospective data from 108 elderly patients who were newly diagnosed with MM from January 2007 to July 2015 were analyzed in a single hematology center. EM was defined as death of any cause within 12 months after diagnosis. A multivariate regression model was used to evaluate EM. Results EM occurred in 16 (14.8%) elderly patients with newly diagnosed MM. The most common cause of death was infection (10/16, 62.5%). In the multivariate analysis, only an age of ≥75 years, International Staging System (ISS) stage III disease, and high lactate dehydrogenase concentration were significantly and independently associated with EM. Conclusion Our results suggest that infection is the leading cause of EM in elderly patients with MM. An age of ≥75 years, ISS stage III disease, and a high lactate dehydrogenase concentration are significant predictors of EM. We should further target this higher-risk patient population to define personalized therapy with which to improve outcomes.

Serum Levels of OPG and MIP-1α in Untreated Multiple Myeloma Patients. Correlations with Staging, Survival and Bone Disease.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 5074-5074
Author(s):  
Argyro Papadogiannis ◽  
Marie-Cristine Kyrtsonis ◽  
Theodoros P. Vassilakopoulos ◽  
Tatiana Tzenou ◽  
Antonios G. Antoniadis ◽  
...  
Keyword(s):  
Bone Disease ◽  
Staging System ◽  
Serum Levels ◽  
High Serum ◽  
Stage I ◽  
Stage Ii ◽  
Stage Iii ◽  
Bone Lesions ◽  
Disease Biology ◽  
Significant Difference

Abstract Cytokines, such as MIP-1a (macrophage inhibiting factor) and OPG (osteoprotegerin) are assumed to play a role in MM disease biology and bone disease, by mechanisms that are still under investigation. MIP-1a is constitutively secreted by myeloma cells, plays a possible role in the development of MM bone lesions, enhance MM cell adhesion to stromal cells and its serum levels have been recently related to survival in MM. OPG is a soluble decoy receptor which acts as a soluble receptor antagonist that prevents osteoclasts activation and the development of bone disease. Reported findings on serum OPG levels in MM patients are controversial as well as its possible role in the biology of the disease. In order to investigate the possible relationship of MIP-1a and OPG levels in MM patients with prognosis and bone disease, we determined by ELISA serum MIP-1a and OPG levels in 20 MGUS, 82 MM patients and 27 healthy individuals (HI). Both cytokines were determined by ELISA (R&D, Quantikine, USA) in frozen sera collected at dignosis, before treatment. The median age of MM patients was 69 years (44–84) and 50% were males. MM patients’ stage was as follows: 23 stage I, 28 stage II, 31 stage III according to Durie-Salmon staging system and 27 stage I, 17 stage II, 35 stage III according to the International Scoring System (ISS). In HI median MIP-1a was 28 pg/ml (15–54) and median OPG 1600 pg/ml (450–4600). In subjects with MGUS, median MIP-1a was 34 pg/ml (17–58) and median OPG 2300 pg/ml (820–6200). In MM patients, median pretreatment serum MIP-1a was 32 pg/ml (16–100) and OPG 3000 pg/ml (820–25000). No statistical significant difference was observed between HI, MGUS and MM patients with regard to MIP-1a levels but for OPG levels differences between HI and MM patients and between MGUS and MM patients were both significant (0.01 and 0.05 respectively). No relationship was found between MIP-1a or OPG levels and bone disease. However, there was a trend for longer survival in patients with MIP-1a or OPG levels lower than median (5-year overall survival 60 ± 12 vs 38 ± 14, p=0.08 and 66 ± 13 vs 29 ± 13, p=0.07 respectively). In addition MIP-1a levels were correlated with ISS stage: MIP-1a levels were 28.3±11.3 in ISS stage 1, 29.8±11.1 in ISS stage 2, 39±19.2 in ISS stage 3 (p=0.02). In conclusion, in our experience serum OPG levels are higher in MM patients than in MGUS or HI, MIP-1a levels are correlated with the ISS stage and both high serum MIP-1a and OPG levels at diagnosis are related with a shorter survival.

Sign in / Sign up

Export Citation Format

Share Document