International Staging System (ISS) Is Superior to Durie-Salmon (DS) Staging in Predicting Overall Mortality in Multiple Myeloma (MM)

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 2745-2745 ◽  
Author(s):  
Sikander Ailawadhi ◽  
Taimur Sher ◽  
Mehul Patel ◽  
Lyudmyla Derby ◽  
Terry Mashtare ◽  
...  
Keyword(s):  
Survival Data ◽  
Staging System ◽  
Stage I ◽  
Stage Iii ◽  
Disease Stage ◽  
Cell Transplant ◽  
Transplant Patients ◽  
Stage Disease ◽  
Staging Systems ◽  
International Staging System

Abstract Background: Despite recent therapeutic advancements, multiple myeloma (MM) remains an incurable disorder. Disease stage is the most commonly used parameter to determine tumor burden, need for treatment initiation and survival outcome. In this context the International Staging System (ISS) proposed in 2005 is considered a good predictor of overall survival (OS) and is reported to be more objective than the previous Durie-Salmon staging system (DSS). To date there has been no direct comparison to determine which of these is superior in predicting OS or mortality. Furthermore, ISS was defined prior to the routine availability of novel agents and primarily included MM patients who had undergone autologous stem cell transplant. Whether ISS has similar predictive value in non-transplant patients has not been reported. We investigated the ability to predict OS and mortality of these two staging systems in non-transplant patients with MM. Methods: All MM patients seen at RPCI between January 2004 and June 2007 were included in the analysis. Clinical staging was done as per the DSS and ISS in all patients. Descriptive baseline demographic data and survival data were collected. A 0.05 nominal significance level was used in all hypothesis testing. Results: A total of 170 consecutive patients were evaluated. None of the patients had undergone a stem cell transplant for their MM diagnosis. Survival data was available on 144 patients which are reported in this analysis. Of these 48% (n=69) were females and 52% (n=75) were males, with a median age of 60 years (range 35–83). The DSS revealed a distribution as follows: stage IA (21; 14.6%), stage IB (1; 0.7%), stage IIA (23; 16%), stage IIB (1; 0.7%), stage IIIA (81; 56.2%) and stage IIIB (17; 11.8%). The distribution as per ISS was stage I (76; 52.8%), stage II (31; 21.5%) and stage III (37; 25.7%). A Cox proportional hazards model was fit to compute a generalized R-square (Gen R2) statistic for the two staging systems and to compute hazard ratios (HR). The Gen R2 for DSS was 0.0259, while for ISS was 0.0461. Thus, by themselves, the two staging systems were not particularly predictive of OS. Comparison was then made by separating stage III (advanced stage disease) from stage I and II for both DSS and ISS. The estimated hazard of death for DSS I/II patients was not significantly different from the estimated hazard of death for DSS III patients (HR=0.48; 95% CI 0.2,1.14; p=0.09), while the estimated hazard of death for ISS I/II patients was significantly different from that for ISS III patients (HR=0.43; 95% CI 0.21,0.85; p=0.01). Exact odds ratios (OR) were computed between dichotomized DSS or ISS stage with patient status at years 1, 2 and 3 of follow up. Survival analysis at 1-year, 2-year and 3-year time point included 112, 93 and 77 patients, respectively. At 1-year, the sample odds of death for stage I/II patients were significantly different from the sample odds of death for stage III patients in both, the DSS (OR=0.32; 95% CI 0.1,0.93; p=0.02) and ISS (OR=0.25; 95% CI 0.08,0.25; p=0.005). At 2-year as well, this difference was significant for both, DSS (OR=0.32; 95% CI 0.1,0.98; p=0.03) and ISS (OR=0.18; 95% CI 0.06,0.63; p=0.002). At 3-year though, the DSS was no longer able to predict a significant difference in the sample odds of death between stage I/II and stage III patients (OR=0.4; 95% CI 0.11,1.34; p=0.11), while the sample odds of death as per the ISS were still significantly different (OR=0.21; 95% CI 0.04, 0.78; p=0.01). Conclusions: Our data from a prospective large cohort of non-transplant MM patients suggests that ISS is more predictive of overall mortality than the DSS. Furthermore, when comparing advanced stage disease (stage III) with early-stage disease (stage I/II), the DSS may only be able to predict short-term survival, while ISS is able to effectively predict survival over a prolonged period. Figure Figure

A Comparison of 3 Staging Systems for the Outcome Following Autologous Stem Cell Transplantation (ASCT) in Patients with Multiple Myeloma (MM).

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 5479-5479
Author(s):  
Hee-Jung Sohn ◽  
Kihyun Kim ◽  
Jae-Hoon Lee ◽  
Soo-Mee Bang ◽  
Dong Hwan Kim ◽  
...  
Keyword(s):  
Overall Survival ◽  
Gold Standard ◽  
Staging System ◽  
Stage I ◽  
Event Free Survival ◽  
Free Survival ◽  
Staging Systems ◽  
International Staging System ◽  
Beta 2 Microglobulin

Abstract The Durie-Salmon (DS) stage has been the gold standard for stratification of MM patients. However, the system does not contain beta-2 microglobulin (B2M) widely recognized as the single most powerful prognostic parameter. Recently, The Southwest Oncology Group (SWOG) staging system (Jacobson JL, et al. Br J Haematol122:441–50, 2003) and the International Staging System (ISS) (Greipp PR, et al. J Clin Oncol23:3412–20, 2005) utilizing B2M have been proposed. We aimed to evaluate whether the stage assessed at the time of ASCT by DS, SWOG, or ISS predict outcome following ASCT in patients with MM. Between November 1996 and December 2004, a total of 141 patients with MM who were treated with ASCT at 5 institutions in Korea were available for this analysis. The distribution of patients’ stage at ASCT by 3 staging systems was as Table 1. With a median follow-up of 20 months from ASCT, the median event-free survival (EFS) and overall survival (OS) were 16 months (95% confidence interval [CI], 11–21) and 56 months (95% CI, 38–74), respectively. The median survival of each stage group according to 3 staging systems at ASCT was as Table 2. Differences in EFS among the stage groups were not statistically significant. However, OS after ASCT was dependent on the SWOG stage at the time of ASCT and also significantly longer in patients with ISS stage I than others (NR vs. 39 months, P =.001). In this study, OS following ASCT was influenced by the stage according to SWOG or ISS, but not DS. The distribution of patients by 3 staging systems Stage I II III IV DS 32 (23%) 23 (16%) 86 (61%) - SWOG 53 (38%) 66 (47%) 16 (11%) 6 (4%) ISS 85 (60%) 34 (24%) 22 (16%) - Median event-free survial and overall survival by 3 staging systems Stage I II III IV P EFS=evnet-free survival, OS=overall survival, NR=not reached, * in months EFS* DS 27 17 13 - .40 SWOG 22 15 24 4 .21 ISS 17 13 10 - .63 OS* DS NR 58 40 - .17 SWOG NR 41 32 17 .045 ISS NR 32 40 - .0042

Myeloma International Staging System Retains Its Prognostic Value at Disease Relapse.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 1474-1474
Author(s):  
Rajanshu Verma ◽  
Shaji Kumar ◽  
Martha Q. Lacy ◽  
Angela Dispenzieri ◽  
Suzanne Hayman ◽  
...  
Keyword(s):  
Overall Survival ◽  
Stem Cell ◽  
Prognostic Value ◽  
Staging System ◽  
Autologous Stem Cell Transplant ◽  
Stage I ◽  
Cell Transplant ◽  
Newly Diagnosed ◽  
International Staging System ◽  
Beta 2 Microglobulin

Abstract Background: The international staging system is a simple, but powerful staging system that is based on two simple and easily available laboratory measurements. The system was developed and validated on a large group pf patients from across the world and has become the standard for patients with newly diagnosed myeloma. While it’s prognostic value is clear in patients with newly diagnosed myeloma, its value at relapse has not been explored. Methods: We examined a uniform cohort of patients relapsing after an autologous stem cell transplant to assess the utility of ISS determined at the time of documented relapse. Relapse was defined using standard EBMTR response criteria. Beta-2 microglobulin and albumin values from within 30 days of the date of relapse were extracted from the medical records. ISS was determined based on the published cut offs. Results: Of the 389 patients evaluated, 132 had values available for B2M and 276 patients had the serum albumin available. Only 131 patients had both the data available and the ISS stage could be determined. Of these patients, 64 patients (49%) were ISS stage I, 50 (38%) were stage II and 17 (13%) were stage III. An albumin < 3.5 mg/dL was prognostic for overall survival post relapse with a median survival of 10.5 months for those with albumin < 3.5 mg/dL compared to 26.3 months for the rest of the group (P < 0.0001). Similarly the median OS from relapse was 15 months for those with B2M > 3.5 mg/dL compared to 23.3 months for those with lower B2M (P = 0.014). The ISS stage predicted overall survival for this group of patients with the OS from relapse estimated at 27.3 mos, 17.8 mos and 12.3 months for ISS stage I, II and III respectively. Conclusions: In a uniform group of patients relapsing after autologous stem cell transplantation, the B2M and albumin maintain their prognostic value and allows the use of the International Staging System for determining prognosis. This supports the use of ISS stage in relapsed trials and will allow comparisons across studies. Results should be validated in a larger dataset that will allow comparisons to other known prognostic factors. Figure Figure

Adult granulosa cell tumors (GCT): 56 years of clinicopathologic outcomes including FOXL2 mutational status.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 5536-5536
Author(s):  
Michelle Wilson ◽  
Roseanne Rosario ◽  
Kathryn F. Chrystal ◽  
Kathryn Payne ◽  
Barrie David Evans ◽  
...  
Keyword(s):  
Hormonal Therapy ◽  
Survival Data ◽  
Early Stage ◽  
Stage I ◽  
Stage Iii ◽  
Disease Stage ◽  
Late Relapse ◽  
Mutation Status ◽  
Mutational Status ◽  
Risk Of Relapse

5536 Background: GCT account for 2-3% of ovarian cancers with a tendency for late relapse. Treatment is primarily surgical. The role of chemotherapy and hormonal therapy is more controversial. The FOXL2 mutation (402C→G) has been identified as a potential driver mutation and may be useful in diagnosis and treatment. Methods: We performed a retrospective review of GCT patients (pts) referred to the Auckland Gynae-Oncology Multidisciplinary Team from 1955 to 2011. Baseline characteristics, clinical course, histopathology and survival data was recorded. FOXL2 mutation status was determined by DNA sequencing, and correlated with clinical data. Results: 56 GCT pts were identified. Median (med) age 48.6 years (y) (22-86). Stage I were 82.1%. 48% of tumours were ≥10cm. Med follow up was 10.0y (0.2-40.4). 25 pts progressed, med time to progression (TTP) was 4.5y (0.1-17.7). Med progression free survival was 14.5y. Med overall survival (OS) was 21.8y but med disease specific survival was not reached. 9/18 pts died of disease. Stage III GCT and size ≥10cm had a higher risk of relapse (RR 3.1 and 2.9) and death (RR 8.2 and 8.6) respectively. 17/46 (37%) Stage I pts progressed. Med TTP was 8.3y (1.3 to 17.7), med OS was 29.0y. Stage I relapse rate was higher in tumours ≥10cm (RR 3.9 p<0.01). 12/17 1st relapses were treated with surgery. 10/17 pts received ≥1 line of chemotherapy and 7 ≥1 hormonal therapy. Clinical benefit rates (CR, PR and SD>6m) for first-line chemotherapy was 25% and 71% for hormones. All 7 Stage III pts progressed with med OS of 6.3yr (0.2-12.3y). Currently the FOXL2 mutation statuses are known for 18 patients. 89% carried the mutation. Homozygous, heterozygous and wild-type mutations had no difference in risk of relapse or death. Further FOXL2 mutation analysis is ongoing. Conclusions: This long term series confirms the protracted natural history of this disease. Early stage GCT, despite progression has a good prognosis with med OS >25y. Stage and tumour size remain the most consistent prognostic factors. Whilst surgery remains the mainstay of therapy, the high response rate to hormonal therapy deserves investigation. Currently the FOXL2 mutation status does not appear prognostic but this needs further research.

scholarly journals Masaoka-Koga and TNM Staging System in Thymic Epithelial Tumors: Prognostic Comparison and the Role of the Number of Involved Structures

Cancers ◽  
2021 ◽  
Vol 13 (21) ◽  
pp. 5254
Author(s):  
Marco Chiappetta ◽  
Filippo Lococo ◽  
Luca Pogliani ◽  
Isabella Sperduti ◽  
Diomira Tabacco ◽  
...  
Keyword(s):  
Staging System ◽  
Tnm Staging ◽  
Multiple Organ ◽  
Stage I ◽  
Stage Ii ◽  
Stage Iii ◽  
Thymic Epithelial Tumors ◽  
Epithelial Tumors ◽  
Tnm Staging System ◽  
Staging Systems

Background: The aim of this study was to evaluate the Masaoka–Koga and the tumor node metastases (TNM) staging system in thymic epithelial tumors (TET) considering possible improvements. Methods: We reviewed the data of 379 patients who underwent surgical resection for TET from 1 January 1985 to 1 January 2018, collecting and classifying the pathological report according to the Masaoka–Koga and the TMN system. The number of involved organs was also considered as a possible prognostic factor and integrated in the two staging systems to verify its impact. Results: Considering the Masaoka–Koga system, 5- and 10-year overall survival (5–10YOS) was 96.4% and 88.9% in stage I, 95% and 89.5% in stage II and 85.4% and 72.8% in stage III (p = 0.01), with overlapping in stage I and stage II curves. Considering the TNM system, 5–10YOS was 95.5% and 88.8% in T1, 84.8% and 70.7% in T2 and 88% and 76.3% in T3 (p = 0.02), with overlapping T2–T3 curves. Including the number of involved structures, in Masaoka–Koga stage III, patients with singular involved organs had a 100% and 76.6% vs. 87.7% 5–10YOS, which was 76.6% in patients with multiple organ infiltration. Considering the TNM, T3 patients with singular involved structures presented a 5–10YOS of 100% vs. 62.5% and 37.5% in patients with multiple organ involvement (p = 0.07). Conclusion: The two staging systems present limitations due to overlapping curves in early Masaoka–Koga stages and in advanced T stages for TNM. The addition of the number of involved organs seems to be a promising factor for the prognosis stratification in these patients.

scholarly journals Prospective international validation of the predisposition, infection, response and organ dysfunction (PIRO) clinical staging system among intensive care and general ward patients

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
T. Cardoso ◽  
P. P. Rodrigues ◽  
C. Nunes ◽  
M. Almeida ◽  
J. Cancela ◽  
...  
Keyword(s):  
Intensive Care ◽  
Organ Dysfunction ◽  
Stage Iv ◽  
Staging System ◽  
Stage I ◽  
Stage Iii ◽  
Disease Stage ◽  
Clinical Staging ◽  
Operating Characteristics ◽  
Infection Response

Abstract Background Stratifying patients with sepsis was the basis of the predisposition, infection, response and organ dysfunction (PIRO) concept, an attempt to resolve the heterogeneity in treatment response. The purpose of this study is to perform an independent validation of the PIRO staging system in an international cohort and explore its utility in the identification of patients in whom time to antibiotic treatment is particularly important. Methods Prospective international cohort study, conducted over a 6-month period in five Portuguese hospitals and one Australian institution. All consecutive adult patients admitted to selected wards or the intensive care, with infections that met the CDC criteria for lower respiratory tract, urinary, intra-abdominal and bloodstream infections were included. Results There were 1638 patients included in the study. Patients who died in hospital presented with a higher PIRO score (10 ± 3 vs 8 ± 4, p < 0.001). The observed mortality was 3%, 15%, 24% and 34% in stage I, II, III and IV, respectively, which was within the predicted intervals of the original model, except for stage IV patients that presented a lower mortality. The hospital survival rate was 84%. The application of the PIRO staging system to the validation cohort resulted in a positive predictive value of 97% for stage I, 91% for stage II, 85% for stage III and 66% for stage IV. The area under the receiver operating characteristics curve (AUROC) was 0.75 for the all cohort and 0.70 if only patients with bacteremia were considered. Patients in stage III and IV who did not have antibiotic therapy administered within the desired time frame had higher mortality rate than those who have timely administration of antibiotic. Conclusions To our knowledge, this is the first external validation of this PIRO staging system and it performed well on different patient wards within the hospital and in different types of hospitals. Future studies could apply the PIRO system to decision-making about specific therapeutic interventions and enrollment in clinical trials based on disease stage.

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 &lt; 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 &gt; 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&lt;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.

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.

scholarly journals The Limited & Extensive Staging System Is More Suitable for Extranodal Natural Killer/T-Cell Lymphoma, Nasal Type: Comparison with Other Staging Systems

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 4155-4155
Author(s):  
Jie Liu ◽  
Chong Jiang ◽  
Yao-Tiao Deng ◽  
Li Zhang ◽  
Na Li ◽  
...  
Keyword(s):  
Risk Factor ◽  
Lymph Node ◽  
Performance Status ◽  
Staging System ◽  
Stage I ◽  
Stage Iii ◽  
Survival Curves ◽  
Limited Disease ◽  
Extensive Disease ◽  
Staging Systems

Abstract Introduction The staging system for extranodal natural killer/T-cell lymphoma, nasal type (ENKTL) remains to be an open issue. The purpose of this retrospective study was to determine the performance of four staging systems for nasal ENKTL: Ann Arbor (AA) stage, limited & extensive stage, stage of Chinese Southwest Oncology Group (CSWOG) and Tumor-Node-Metastasis (TNM) stage. Methods This study was comprised of 233 patients with nasal ENTKL. The AA staging system was based on the Lugano modification of AA stage. The limited & extensive staging system was based on the AA stage, and the presence or absence of local tumor invasiveness: limited disease (AA stage I-II without LTI) and extensive disease (AA stage I-II with LTI or AA stage III-IV). The CSWOG staging system was described as follows: stage I, lesions confined within the upper aerodigestive tract without local invasiveness (paranasal sinuses, bony or skin invasion); stage II, localized disease with local invasiveness; stage III, localized disease with regional lymph node (cervical lymph node) involvement; and the others were stage IV. The TNM staging system was described by previous study (Yan et al. PLoS One, 2015). The 3-year overall survival (OS) rates were estimated using the Kaplan-Meier method, and survival curves were compared by the log-rank test. Multivariate analyses were performed using four separate COX models to assess the prognostic values of AA stage, limited & extensive stage, CSWOG stage and TNM stage, respectively, after adjusted for the effects of other covariates. Results After a median follow-up of 35.5 months, estimated 3-year OS rate was 61.3%. Multivariate analyses showed that limited & extensive stage, gender, performance status, lactate dehydrogenase (LDH), chemotherapy and radiotherapy were predictive of OS. The AA, CSWOG and TNM staging systems were not independent prognostic factors. Based these results, patients were stratified into four groups: low-risk limited disease (without risk factor), high-risk limited disease (with at least one risk factor: male, poor performance status, higher LDH), extensive disease with AA stage I-II and extensive disease with AA stage III-IV, for which the 3-year OS rates were 94.0%, 67.9%, 46.2% and 34.0%, respectively (P<0.050 in all pairwise comparisons). Conclusions The limited & extensive staging system is more suitable for nasal ENKTL than other staging systems. Risk stratification based on this system owns a good ability to discriminate the prognosis of ENKTL patients. Prospective multicenter studies are needed to further confirm these findings. Keywords: Extranodal Lymphoma, NK-T Cells, Staging Figure 1 Survival curves of 233 newly diagnosed patients with ENKTL according to each staging system. Figure 1. Survival curves of 233 newly diagnosed patients with ENKTL according to each staging system. Figure 2 Survival curves of 233 newly diagnosed patients with ENKTL according to risk stratification. Group 1, low-risk limited disease (without risk factor); Group 2, high-risk limited disease (with at least one risk factor: male, poor performance status, higher LDH); Group 3, extensive disease with AA stage I-II; and Group 4, extensive disease with AA stage III-IV. Note: a Patients treated without chemotherapy, with non-asparaginase-based chemotherapy and with asparaginase-containing chemotherapy were assigned the value 1, 2 and 3, respectively. A larger value of likelihood ratio 2 and a smaller value of −2 log likelihood indicated a better model for predicting outcome. CSWOG, Chinese Southwest Oncology Group; DLN, distant lymph node; LDH, lactic dehydrogenase; RLN, regional lymph node; TNM, Tumor-Node-Metastasis. Figure 2. Survival curves of 233 newly diagnosed patients with ENKTL according to risk stratification. Group 1, low-risk limited disease (without risk factor); Group 2, high-risk limited disease (with at least one risk factor: male, poor performance status, higher LDH); Group 3, extensive disease with AA stage I-II; and Group 4, extensive disease with AA stage III-IV. / Note: a Patients treated without chemotherapy, with non-asparaginase-based chemotherapy and with asparaginase-containing chemotherapy were assigned the value 1, 2 and 3, respectively. A larger value of likelihood ratio 2 and a smaller value of −2 log likelihood indicated a better model for predicting outcome. CSWOG, Chinese Southwest Oncology Group; DLN, distant lymph node; LDH, lactic dehydrogenase; RLN, regional lymph node; TNM, Tumor-Node-Metastasis. Disclosures No relevant conflicts of interest to declare.

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