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Myeloma

Is the international staging system superior to the Durie–Salmon staging system? A comparison in multiple myeloma patients undergoing autologous transplant

Abstract

The international staging system (ISS) for multiple myeloma (MM) is a validated alternative to the Durie–Salmon staging system (DSS) for predicting survival at diagnosis. We compared these staging systems for predicting outcomes after upfront autologous stem cell transplantation by analyzing the outcomes of 729 patients between 1995 and 2002. With a median follow-up of 56 months, the univariate probabilities (95% CI) of non-relapse mortality (NRM), relapse, progression-free survival (PFS) and overall survival (OS) at 5 years were 7, 68, 25 and 52%, respectively. The median OS for stages I, II, III by DSS and ISS were 82, 68, 50 and 64, 68, 45 months, respectively. The concordance between the two staging systems was only 36%. Staging systems were formally compared using Cox models fit with DSS and ISS stages. The relative risks of PFS and OS were significantly different for stages I vs II and II vs III for DSS, but only for stages II vs III for ISS. Although both systems were predictive of PFS and OS, the DSS was superior in formal statistical comparison using Brier score. However, neither system was strongly predictive of outcomes, indicating the need for newer schemes incorporating other prognostic markers.

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References

  1. Durie BG, Salmon SE . A clinical staging system for multiple myeloma. Correlation of measured myeloma cell mass with presenting clinical features, response to treatment, and survival. Cancer 1975; 36: 842–854.

    Article  CAS  PubMed  Google Scholar 

  2. Greipp PR, San Miguel J, Durie BG, Crowley JJ, Barlogie B, Blade J et al. International staging system for multiple myeloma. J Clin Oncol 2005; 23: 3412–3420.

    Article  PubMed  Google Scholar 

  3. Merlini G, Waldenstrom JG, Jayakar SD . A new improved clinical staging system for multiple myeloma based on analysis of 123 treated patients. Blood 1980; 55: 1011–1019.

    CAS  PubMed  Google Scholar 

  4. Bataille R, Durie BG, Grenier J, Sany J . Prognostic factors and staging in multiple myeloma: a reappraisal. J Clin Oncol 1986; 4: 80–87.

    Article  CAS  PubMed  Google Scholar 

  5. Blade J, Rozman C, Cervantes F, Reverter JC, Montserrat E . A new prognostic system for multiple myeloma based on easily available parameters. Br J Haematol 1989; 72: 507–511.

    Article  CAS  PubMed  Google Scholar 

  6. Medical Research Council's Working Party on Leukemia in Adults. Prognostic features in the third MRC myelomatosis trial. Br J Cancer 1980; 42: 831–840.

    Article  Google Scholar 

  7. Hungria VT, Maiolino A, Martinez G, Colleoni GW, Coelho EO, Rocha L et al. Confirmation of the utility of the International Staging System and identification of a unique pattern of disease in Brazilian patients with multiple myeloma. Haematologica 2008; 93: 791–792.

    Article  PubMed  Google Scholar 

  8. Gassmann W, Pralle H, Haferlach T, Pandurevic S, Graubner M, Schmitz N et al. Staging systems for multiple myeloma: a comparison. Br J Haematol 1985; 59: 703–711.

    Article  CAS  PubMed  Google Scholar 

  9. Kim H, Sohn HJ, Kim S, Kim K, Lee JH, Bang SM et al. New staging systems can predict prognosis of multiple myeloma patients undergoing autologous peripheral blood stem cell transplantation as first-line therapy. Biol Blood Marrow Transplant 2006; 12: 837–844.

    Article  PubMed  Google Scholar 

  10. Salmon SE, Durie BG . Cellular kinetics in multiple myeloma. A new approach to staging and treatment. Arch Intern Med 1975; 135: 131–138.

    Article  CAS  PubMed  Google Scholar 

  11. Blade J, Samson D, Reece D, Apperley J, Bjorkstrand B, Gahrton G et al. Criteria for evaluating disease response and progression in patients with multiple myeloma treated by high-dose therapy and haemopoietic stem cell transplantation. Myeloma Subcommittee of the EBMT. European Group for Blood and Marrow Transplant. Br J Haematol 1998; 102: 1115–1123.

    Article  CAS  PubMed  Google Scholar 

  12. Klein J, Moeschberger M . Survival Analysis: Techniques of Censored and Truncated Data, 2nd edn. Springer-Verlag: New York, NY, 2003.

    Google Scholar 

  13. Kaplan E . Nonparametric estimation from incomplete observations. J Am Stat Assoc 1958; 53: 457–481.

    Article  Google Scholar 

  14. Cohen J . A coefficient of agreement for nominal scale. J Educat Psychol Measurement 1960; 20: 37–46.

    Article  Google Scholar 

  15. Brennan P, Silman A . Statistical methods for assessing observer variability in clinical measures. BMJ 1992; 304: 1491–1494.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Cox DR . Regression models an d life tables. J R Stat Soc B 1972; 34: 187–200.

    Google Scholar 

  17. Graf E, Schmoor C, Sauerbrei W, Schumacher M . Assessment and comparison of prognostic classification schemes for survival data. Stat Med 1999; 18: 2529–2545.

    Article  CAS  PubMed  Google Scholar 

  18. Spiegelhalter DJ . Probabilistic prediction in patient management and clinical trials. Stat Med 1986; 5: 421–433.

    Article  CAS  PubMed  Google Scholar 

  19. Brier G . Verifications of forecasts expressed in terms of probability. Monthly Weather Review 1950; 78: 1–3.

    Article  Google Scholar 

  20. Attal M, Harousseau JL, Stoppa AM, Sotto JJ, Fuzibet JG, Rossi JF et al. A prospective, randomized trial of autologous bone marrow transplantation and chemotherapy in multiple myeloma. Intergroupe Francais du Myelome. N Engl J Med 1996; 335: 91–97.

    Article  CAS  PubMed  Google Scholar 

  21. Child JA, Morgan GJ, Davies FE, Owen RG, Bell SE, Hawkins K et al. High-dose chemotherapy with hematopoietic stem-cell rescue for multiple myeloma. N Engl J Med 2003; 348: 1875–1883.

    Article  CAS  PubMed  Google Scholar 

  22. Krejci M, Buchler T, Hajek R, Svobodnik A, Krivanova A, Pour L et al. Prognostic factors for survival after autologous transplantation: a single centre experience in 133 multiple myeloma patients. Bone Marrow Transplant 2005; 35: 159–164.

    Article  CAS  PubMed  Google Scholar 

  23. Tao ZF, Fu WJ, Yuan ZG, Wang DX, Chen YB, Hou J . Prognostic factors and staging systems of multiple myeloma. Chin Med J (Engl) 2007; 120: 1655–1658.

    Article  CAS  Google Scholar 

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Correspondence to P N Hari.

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Supplementary Information accompanies the paper on the Leukemia website (http://www.nature.com/leu)

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Hari, P., Zhang, MJ., Roy, V. et al. Is the international staging system superior to the Durie–Salmon staging system? A comparison in multiple myeloma patients undergoing autologous transplant. Leukemia 23, 1528–1534 (2009). https://doi.org/10.1038/leu.2009.61

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