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Is the International Staging System superior to the Durie-Salmon staging system? A comparison in multiple myeloma patients undergoing autologous transplant. Leukemia 2009 Aug;23(8):1528-34 PMID: 19322205 PMCID: PMC2726276

Pubmed ID





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.

Author List

Hari PN, Zhang MJ, Roy V, PĂ©rez WS, Bashey A, To LB, Elfenbein G, Freytes CO, Gale RP, Gibson J, Kyle RA, Lazarus HM, McCarthy PL, Milone GA, Pavlovsky S, Reece DE, Schiller G, Vela-Ojeda J, Weisdorf D, Vesole D


Parameswaran Hari MD Chief, Professor in the Medicine department at Medical College of Wisconsin
Mei-Jie Zhang PhD Professor in the Institute for Health and Equity department at Medical College of Wisconsin


2-s2.0-68749084622   40 Citations

MESH terms used to index this publication - Major topics in bold

Disease Progression
Disease-Free Survival
Follow-Up Studies
Hematopoietic Stem Cell Transplantation
Kaplan-Meier Estimate
Middle Aged
Multiple Myeloma
Neoplasm Staging
Predictive Value of Tests
Proportional Hazards Models
Retrospective Studies
Transplantation Conditioning
Transplantation, Autologous
Treatment Outcome
jenkins-FCD Prod-331 a335b1a6d1e9c32173c9534e6f6ff51494143916