R2-ISS — Second Revision International Staging System for Multiple Myeloma
Updated staging for newly-diagnosed multiple myeloma (D'Agostino, IMS 2022). Adds 1q+ to ISS, LDH and high-risk cytogenetics. Stratifies four risk groups (Low / Low-intermediate / Intermediate-high / High).
Score interpretation
R2-ISS 0 points.
→ Standard induction (VRd or DaraVRd); ASCT if eligible; lenalidomide maintenance.
R2-ISS 0.5–1 points.
→ DaraVRd induction; ASCT if eligible; lenalidomide maintenance; consider trial enrolment.
R2-ISS 1.5–2.5 points.
→ Quadruplet induction (DaraVRd / Isa-KRd); tandem ASCT consideration; bortezomib + lenalidomide maintenance; trial enrolment encouraged.
R2-ISS 3–5 points.
→ Quadruplet induction; tandem ASCT; intensified maintenance (PI + IMiD); consider early CAR-T or bispecific antibody trials; tight monitoring for relapse.
Interpretation bands for the R2-ISS. Apply clinical judgement and local guidance.
References
- D'Agostino M, Cairns DA, Lahuerta JJ, et al. Second Revision of the International Staging System (R2-ISS) for overall survival in multiple myeloma: a European Myeloma Network (EMN) report within the HARMONY project. J Clin Oncol. 2022;40(29):3406-3418.
Related
Curated clinical cross-links plus same-class fallbacks.
- Phenytoin / Fosphenytoin · Antiepileptic — Status Epilepticus (Second-Line)
- Levetiracetam (IV) · Antiepileptic — Status Epilepticus (Second-Line)
- Cetirizine · Second-generation antihistamine (H1 antagonist)
- Fexofenadine 120mg / 180mg Tablets · Second-generation (non-sedating) antihistamine — H1 antagonist
- Loratadine 10mg Tablets · Second-generation (non-sedating) antihistamine — H1 antagonist
- Acrivastine · Antihistamine (H1, second-generation)
- 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.