Staging Systems for Newly Diagnosed Myeloma Patients Undergoing Autologous Hematopoietic Cell Transplantation: The Revised International Staging System Shows the Most Differentiation between Groups

Emma Scott, Parameswaran Hari, Sathish Kumar, Raphael Fraser, Omar Davila, Nina Shah, Robert Peter Gale, Miguel Angel Diaz, Vaibhav Agrawal, Robert F. Cornell, Siddhartha Ganguly, Gorgun Akpek, Cesar Freytes, Shahrukh Hashmi, Ehsan Malek, Rammurti T. Kamble, Hillard Lazarus, Melhem Solh, Saad Z. Usmani, Abraham S. KanateAyman Saad, Saurabh Chhabra, Usama Gergis, Jan Cerny, Robert A. Kyle, Cindy Lee, Tamila Kindwall-Keller, Amer Assal, Gerhard C. Hildebrandt, Leona Holmberg, Richard Maziarz, Taiga Nishihori, Sachiko Seo, Shaji Kumar, Tomer Mark, Anita D'Souza

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

The Revised International Staging System (R-ISS) and the International Myeloma Working Group 2014 (IMWG 2014) are newer staging systems used to prognosticate multiple myeloma (MM) outcomes. We hypothesized that these would provide better prognostic differentiation for newly diagnosed multiple myeloma (MM) compared with ISS. We analyzed the Center for International Blood and Marrow Transplant Research database from 2008 to 2014 to compare the 3 systems (N = 628) among newly diagnosed MM patients undergoing upfront autologous hematopoietic cell transplantation (AHCT). The median follow-up of survivors was 48 (range, 3 to 99) months. The R-ISS provided the greatest differentiation between survival curves for each stage (for overall survival [OS], the differentiation was 1.74 using the R-ISS, 1.58 using ISS, and 1.60 using the IMWG 2014). Univariate analyses at 3 years for OS showed R-ISS I at 88% (95% confidence interval [CI], 83% to 93%), II at 75% (95% CI, 70% to 80%), and III at 56% (95% CI, 3% to 69%; P <.001). An integrated Brier score function demonstrated the R-ISS had the best prediction for PFS, though all systems had similar prediction for OS. Among available systems, the R-ISS is the most optimal among available prognostic tools for newly diagnosed MM undergoing AHCT. We recommend that serum lactate dehydrogenase and cytogenetic data be performed on every MM patient at diagnosis to allow accurate prognostication.

Original languageEnglish (US)
Pages (from-to)2443-2449
Number of pages7
JournalBiology of Blood and Marrow Transplantation
Volume24
Issue number12
DOIs
StatePublished - Dec 1 2018

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Cell Transplantation
Multiple Myeloma
Survival
Confidence Intervals
L-Lactate Dehydrogenase
Cytogenetics
Survivors
Bone Marrow
Databases
Transplants
Serum
Research

Keywords

  • International staging system
  • Revised international staging system
  • Staging system comparison

ASJC Scopus subject areas

  • Hematology
  • Transplantation

Cite this

Staging Systems for Newly Diagnosed Myeloma Patients Undergoing Autologous Hematopoietic Cell Transplantation : The Revised International Staging System Shows the Most Differentiation between Groups. / Scott, Emma; Hari, Parameswaran; Kumar, Sathish; Fraser, Raphael; Davila, Omar; Shah, Nina; Gale, Robert Peter; Diaz, Miguel Angel; Agrawal, Vaibhav; Cornell, Robert F.; Ganguly, Siddhartha; Akpek, Gorgun; Freytes, Cesar; Hashmi, Shahrukh; Malek, Ehsan; Kamble, Rammurti T.; Lazarus, Hillard; Solh, Melhem; Usmani, Saad Z.; Kanate, Abraham S.; Saad, Ayman; Chhabra, Saurabh; Gergis, Usama; Cerny, Jan; Kyle, Robert A.; Lee, Cindy; Kindwall-Keller, Tamila; Assal, Amer; Hildebrandt, Gerhard C.; Holmberg, Leona; Maziarz, Richard; Nishihori, Taiga; Seo, Sachiko; Kumar, Shaji; Mark, Tomer; D'Souza, Anita.

In: Biology of Blood and Marrow Transplantation, Vol. 24, No. 12, 01.12.2018, p. 2443-2449.

Research output: Contribution to journalArticle

Scott, E, Hari, P, Kumar, S, Fraser, R, Davila, O, Shah, N, Gale, RP, Diaz, MA, Agrawal, V, Cornell, RF, Ganguly, S, Akpek, G, Freytes, C, Hashmi, S, Malek, E, Kamble, RT, Lazarus, H, Solh, M, Usmani, SZ, Kanate, AS, Saad, A, Chhabra, S, Gergis, U, Cerny, J, Kyle, RA, Lee, C, Kindwall-Keller, T, Assal, A, Hildebrandt, GC, Holmberg, L, Maziarz, R, Nishihori, T, Seo, S, Kumar, S, Mark, T & D'Souza, A 2018, 'Staging Systems for Newly Diagnosed Myeloma Patients Undergoing Autologous Hematopoietic Cell Transplantation: The Revised International Staging System Shows the Most Differentiation between Groups', Biology of Blood and Marrow Transplantation, vol. 24, no. 12, pp. 2443-2449. https://doi.org/10.1016/j.bbmt.2018.08.013
Scott, Emma ; Hari, Parameswaran ; Kumar, Sathish ; Fraser, Raphael ; Davila, Omar ; Shah, Nina ; Gale, Robert Peter ; Diaz, Miguel Angel ; Agrawal, Vaibhav ; Cornell, Robert F. ; Ganguly, Siddhartha ; Akpek, Gorgun ; Freytes, Cesar ; Hashmi, Shahrukh ; Malek, Ehsan ; Kamble, Rammurti T. ; Lazarus, Hillard ; Solh, Melhem ; Usmani, Saad Z. ; Kanate, Abraham S. ; Saad, Ayman ; Chhabra, Saurabh ; Gergis, Usama ; Cerny, Jan ; Kyle, Robert A. ; Lee, Cindy ; Kindwall-Keller, Tamila ; Assal, Amer ; Hildebrandt, Gerhard C. ; Holmberg, Leona ; Maziarz, Richard ; Nishihori, Taiga ; Seo, Sachiko ; Kumar, Shaji ; Mark, Tomer ; D'Souza, Anita. / Staging Systems for Newly Diagnosed Myeloma Patients Undergoing Autologous Hematopoietic Cell Transplantation : The Revised International Staging System Shows the Most Differentiation between Groups. In: Biology of Blood and Marrow Transplantation. 2018 ; Vol. 24, No. 12. pp. 2443-2449.
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abstract = "The Revised International Staging System (R-ISS) and the International Myeloma Working Group 2014 (IMWG 2014) are newer staging systems used to prognosticate multiple myeloma (MM) outcomes. We hypothesized that these would provide better prognostic differentiation for newly diagnosed multiple myeloma (MM) compared with ISS. We analyzed the Center for International Blood and Marrow Transplant Research database from 2008 to 2014 to compare the 3 systems (N = 628) among newly diagnosed MM patients undergoing upfront autologous hematopoietic cell transplantation (AHCT). The median follow-up of survivors was 48 (range, 3 to 99) months. The R-ISS provided the greatest differentiation between survival curves for each stage (for overall survival [OS], the differentiation was 1.74 using the R-ISS, 1.58 using ISS, and 1.60 using the IMWG 2014). Univariate analyses at 3 years for OS showed R-ISS I at 88{\%} (95{\%} confidence interval [CI], 83{\%} to 93{\%}), II at 75{\%} (95{\%} CI, 70{\%} to 80{\%}), and III at 56{\%} (95{\%} CI, 3{\%} to 69{\%}; P <.001). An integrated Brier score function demonstrated the R-ISS had the best prediction for PFS, though all systems had similar prediction for OS. Among available systems, the R-ISS is the most optimal among available prognostic tools for newly diagnosed MM undergoing AHCT. We recommend that serum lactate dehydrogenase and cytogenetic data be performed on every MM patient at diagnosis to allow accurate prognostication.",
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AU - Fraser, Raphael

AU - Davila, Omar

AU - Shah, Nina

AU - Gale, Robert Peter

AU - Diaz, Miguel Angel

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AU - Kyle, Robert A.

AU - Lee, Cindy

AU - Kindwall-Keller, Tamila

AU - Assal, Amer

AU - Hildebrandt, Gerhard C.

AU - Holmberg, Leona

AU - Maziarz, Richard

AU - Nishihori, Taiga

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AU - Kumar, Shaji

AU - Mark, Tomer

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