The Durie-Salmon (DS) stage has been the gold standard for stratification of MM patients. However, the system does not contain beta-2 microglobulin (B2M) widely recognized as the single most powerful prognostic parameter. Recently, The Southwest Oncology Group (SWOG) staging system (

Jacobson JL, et al. Br J Haematol 122:441–50, 2003
) and the International Staging System (ISS) (
Greipp PR, et al. J Clin Oncol 23:3412–20, 2005
) utilizing B2M have been proposed. We aimed to evaluate whether the stage assessed at the time of ASCT by DS, SWOG, or ISS predict outcome following ASCT in patients with MM. Between November 1996 and December 2004, a total of 141 patients with MM who were treated with ASCT at 5 institutions in Korea were available for this analysis. The distribution of patients’ stage at ASCT by 3 staging systems was as Table 1. With a median follow-up of 20 months from ASCT, the median event-free survival (EFS) and overall survival (OS) were 16 months (95% confidence interval [CI], 11–21) and 56 months (95% CI, 38–74), respectively. The median survival of each stage group according to 3 staging systems at ASCT was as Table 2. Differences in EFS among the stage groups were not statistically significant. However, OS after ASCT was dependent on the SWOG stage at the time of ASCT and also significantly longer in patients with ISS stage I than others (NR vs. 39 months, P =.001). In this study, OS following ASCT was influenced by the stage according to SWOG or ISS, but not DS.

The distribution of patients by 3 staging systems

StageIIIIIIIV
DS 32 (23%) 23 (16%) 86 (61%) - 
SWOG 53 (38%) 66 (47%) 16 (11%) 6 (4%) 
ISS 85 (60%) 34 (24%) 22 (16%) - 
StageIIIIIIIV
DS 32 (23%) 23 (16%) 86 (61%) - 
SWOG 53 (38%) 66 (47%) 16 (11%) 6 (4%) 
ISS 85 (60%) 34 (24%) 22 (16%) - 
View Large

Median event-free survial and overall survival by 3 staging systems

StageIIIIIIIVP
EFS=evnet-free survival, OS=overall survival, NR=not reached, * in months 
EFS*      
DS 27 17 13 - .40 
SWOG 22 15 24 4 .21 
ISS 17 13 10 - .63 
OS*      
DS NR 58 40 - .17 
SWOG NR 41 32 17 .045 
ISS NR 32 40 - .0042 
StageIIIIIIIVP
EFS=evnet-free survival, OS=overall survival, NR=not reached, * in months 
EFS*      
DS 27 17 13 - .40 
SWOG 22 15 24 4 .21 
ISS 17 13 10 - .63 
OS*      
DS NR 58 40 - .17 
SWOG NR 41 32 17 .045 
ISS NR 32 40 - .0042 
View Large

Topics:
autologous stem cell transplant, multiple myeloma, beta 2-microglobulin, follow-up, gold standard, southwest oncology group, korea, salmon

Author notes

Corresponding author

2005, The American Society of Hematology
2005
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