Faculty Collaboration Database

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

Date

03/27/2009

Pubmed ID

19322205

Pubmed Central ID

PMC2726276

DOI

10.1038/leu.2009.61

Scopus ID

2-s2.0-68749084622 (requires institutional sign-in at Scopus site)   79 Citations

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.

Author List

Hari PN, Zhang MJ, Roy V, Pérez 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

Authors

Parameswaran Hari MD Adjunct 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

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

Adult
Aged
Disease Progression
Disease-Free Survival
Female
Follow-Up Studies
Hematopoietic Stem Cell Transplantation
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Multiple Myeloma
Neoplasm Staging
Predictive Value of Tests
Proportional Hazards Models
Retrospective Studies
Transplantation Conditioning
Transplantation, Autologous
Treatment Outcome