Revised ISS (R-ISS) for Multiple Myeloma
Revised International Staging System for Multiple Myeloma incorporating ISS stage, LDH, and high-risk cytogenetics.
Score interpretation
R-ISS Stage I: ISS I + standard-risk cytogenetics + normal LDH. Median OS not reached (> 5 years).
→ Standard induction: bortezomib-based triplet (VRd: bortezomib + lenalidomide + dexamethasone). ASCT if eligible. Lenalidomide maintenance post-ASCT. Regular M-protein monitoring.
R-ISS Stage II: Not I or III. Median OS ~83 months.
→ Bortezomib-based triplet induction (VRd or VCd). ASCT if eligible. Lenalidomide maintenance. Consider clinical trial. Risk-adapted approach with haematologist.
R-ISS Stage III: ISS III + high-risk cytogenetics OR elevated LDH. Median OS ~43 months.
→ Intensive induction: VRd or daratumumab-based quadruplet (Dara-VRd). ASCT if eligible followed by consolidation. Novel agent trials preferred. Early clinical trial discussion. Close monitoring for progression.
Interpretation bands for the R-ISS Myeloma. Apply clinical judgement and local guidance.
References
- Palumbo A et al. Revised International Staging System for Multiple Myeloma: A Report From International Myeloma Working Group. J Clin Oncol. 2015.
Related
Curated clinical cross-links plus same-class fallbacks.
- Bortezomib · Proteasome Inhibitor — Myeloma
- 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
- 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.