In multiple myeloma, the International Staging System (ISS) uses serum beta-2 microglobulin and albumin. The Revised ISS (R-ISS) adds two additional prognostic parameters. Which pair?

• A Creatinine and bone marrow plasma cell percentage
• B Haemoglobin and 24-hour urinary M protein
• C Free light chain ratio and BM biopsy cellularity
• D LDH and FISH cytogenetics (high-risk: del17p, t(4;14), t(14;16)) ✓

Explanation

The Revised ISS (R-ISS, 2015) adds serum LDH level and FISH-based high-risk cytogenetics to the original beta-2 microglobulin and albumin. High-risk cytogenetics are defined as del(17p), t(4;14), or t(14;16). R-ISS stage III (ISS III plus high LDH or high-risk cytogenetics) has 5-year OS of 40% versus 82% for R-ISS I. This stratification guides intensification strategies and novel agent selection.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.