International Staging System (ISS) for Multiple Myeloma
Predicts overall survival in multiple myeloma using serum β2-microglobulin and albumin. Simple and reproducible staging system used alongside cytogenetics.
Score interpretation
β2M < 3.5 mg/L AND albumin ≥ 35 g/L. Median OS ~62 months.
→ Standard induction therapy (VRd or VCd). ASCT if eligible and fit. Haematology/myeloma MDT. Regular monitoring of paraprotein, calcium, creatinine, FBC.
Neither Stage I nor Stage III criteria. Median OS ~44 months.
→ Standard or enhanced induction (VRd). ASCT if eligible. Consider high-dose dexamethasone. Maintenance lenalidomide post-ASCT. Bisphosphonates (zoledronic acid).
β2M ≥ 5.5 mg/L. Median OS ~29 months. Poor prognosis — especially with high-risk cytogenetics.
→ VRd or daratumumab-based induction. ASCT if fit. High-risk cytogenetics (del17p, t(4;14), t(14;16)): consider bortezomib-based regimen throughout. Clinical trial enrolment. Myeloma MDT.
Interpretation bands for the ISS — Myeloma. Apply clinical judgement and local guidance.
References
- Greipp PR, et al. International staging system for multiple myeloma. J Clin Oncol. 2005;23(15):3412–3420.
Related
Curated clinical cross-links plus same-class fallbacks.
- Noradrenaline (Norepinephrine) · Vasopressor (Alpha-1 and Beta-1 Agonist)
- Dobutamine (ICU — Inotrope) · Inotrope (Beta-1 Agonist)
- Labetalol (IV — Hypertensive Emergency) · Combined Alpha-1 and Beta-Adrenergic Blocker
- Ephedrine hydrochloride · Mixed alpha/beta-adrenergic agonist (vasopressor)
- Sotalol · Antiarrhythmic
- Metoprolol (IV/Oral — Cardiology) · Beta-Blocker
- Major Haemorrhage / Massive Transfusion · BCSH; RCOA; RCEM; RCS — BCSH Guidelines
- Anaemia Investigation · BSH / NICE
- Splenomegaly Workup · BSH; BMJ Best Practice
- Deep Vein Thrombosis Diagnosis and Treatment · NICE CG144 / NICE NG158
- Sickle Cell Crisis · BSH 2021 / BCSH
- Neutropenic Sepsis · NICE CG151 2012 / ESMO
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.