Multiple Myeloma Staging (ISS/R‑ISS): Prognostic Factors and End‑Stage Features

International Staging System (ISS) uses β₂‑microglobulin and albumin. Revised ISS (R‑ISS) adds LDH and cytogenetics (del17p, t(4;14), t(14;16)).

Stage III (ISS) / High‑Risk R‑ISS Features

• β₂‑microglobulin >5.5 mg/L
• Albumin <3.5 g/dL
• Elevated LDH
• High‑risk cytogenetics

End‑Stage / Advanced Disease Manifestations

• Severe anemia (Hb <10 g/dL)
• Renal failure (creatinine >2 mg/dL or dialysis)
• Lytic bone lesions, pathologic fractures, spinal cord compression
• Hypercalcemia (>11 mg/dL)
• Recurrent infections (hypogammaglobulinemia)
• Extramedullary plasmacytomas

Modern therapies (proteasome inhibitors, IMiDs, anti‑CD38 antibodies, CAR‑T, bispecifics) have dramatically improved survival even in high‑risk disease. Treatment is continuous and individualized.