Evaluation of current survival and prognostic factors in multiple myeloma: Staging ISS or R-ISS?

Abstract

Multiple myeloma (MM) is a complex hematological malignancy, and understanding the factors influencing prognosis and survival is crucial for improving patient outcomes. This study aims to evaluate the factors influencing the prognosis and survival of MM patients by comparing the International Staging System (ISS) with the Revised ISS (R-ISS). MM patients treated and followed up between 2015 and 2023 were retrospectively analyzed. According to ISS staging, 21.4% of patients were categorized as Stage 1, 30% as Stage 2, and 48.6% as Stage 3. Similarly, the R-ISS system revealed 14.3% as Stage 1, while 42.9% were Stage 2, and 42.9% were Stage 3. These findings indicate that the two systems provide differing stage distributions, which could impact prognosis evaluation. Mortality occurred in 58.6% of patients during the follow-up period, highlighting the severity of the disease in later stages. Further analysis revealed that higher levels of red cell distribution width (RDW), phosphorus content, lactate dehydrogenase (LDH), and beta-2 microglobulin levels were significantly associated with mortality, emphasizing their potential as markers of poor prognosis. In particular, ISS Stage II and III, R-ISS Stage III, along with elevated RDW, total protein, phosphorus, and LDH, were identified as independent prognostic factors. These results suggest that while both staging systems offer valuable insights, specific biomarkers play a crucial role in refining prognostic accuracy. In conclusion, while the ISS system appears to provide more meaningful staging information in this cohort compared to R-ISS, integrating additional biomarkers like RDW and LDH could enhance the prediction of patient outcomes.