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

P. N. Hari, M. J. Zhang, V. Roy, W. S. Pérez, A. Bashey, L. B. To, G. Elfenbein, C. O. Freytes, R. P. Gale, J. Gibson, R. A. Kyle, H. M. Lazarus, P. L. McCarthy, G. A. Milone, S. Pavlovsky, D. E. Reece, G. Schiller, J. Vela-Ojeda, D. Weisdorf, D. Vesole

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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.

Original languageEnglish (US)
Pages (from-to)1528-1534
Number of pages7
JournalLeukemia
Volume23
Issue number8
DOIs
StatePublished - 2009

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Salmon
Autografts
Multiple Myeloma
Survival
Disease-Free Survival
Stem Cell Transplantation
Proportional Hazards Models
Recurrence
Mortality

ASJC Scopus subject areas

  • Hematology
  • Cancer Research
  • Anesthesiology and Pain Medicine

Cite this

Is the international staging system superior to the Durie-Salmon staging system? A comparison in multiple myeloma patients undergoing autologous transplant. / Hari, P. N.; Zhang, M. J.; Roy, V.; Pérez, W. S.; Bashey, A.; To, L. B.; Elfenbein, G.; Freytes, C. O.; Gale, R. P.; Gibson, J.; Kyle, R. A.; Lazarus, H. M.; McCarthy, P. L.; Milone, G. A.; Pavlovsky, S.; Reece, D. E.; Schiller, G.; Vela-Ojeda, J.; Weisdorf, D.; Vesole, D.

In: Leukemia, Vol. 23, No. 8, 2009, p. 1528-1534.

Research output: Contribution to journalArticle

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 2009, 'Is the international staging system superior to the Durie-Salmon staging system? A comparison in multiple myeloma patients undergoing autologous transplant', Leukemia, vol. 23, no. 8, pp. 1528-1534. https://doi.org/10.1038/leu.2009.61
Hari, P. N. ; Zhang, M. J. ; Roy, V. ; Pérez, W. S. ; Bashey, A. ; To, L. B. ; Elfenbein, G. ; Freytes, C. O. ; Gale, R. P. ; Gibson, J. ; Kyle, R. A. ; Lazarus, H. M. ; McCarthy, P. L. ; Milone, G. A. ; Pavlovsky, S. ; Reece, D. E. ; Schiller, G. ; Vela-Ojeda, J. ; Weisdorf, D. ; Vesole, D. / Is the international staging system superior to the Durie-Salmon staging system? A comparison in multiple myeloma patients undergoing autologous transplant. In: Leukemia. 2009 ; Vol. 23, No. 8. pp. 1528-1534.
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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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AU - To, L. B.

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AU - Vesole, D.

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