A 63-year-old man with newly diagnosed multiple myeloma has del(17p) and t(4;14) on FISH, LDH elevated, and beta-2 microglobulin 5.8 mg/L with albumin 3.2 g/dL. By the R-ISS staging system, this patient is stage:
- A R-ISS Stage I
- B R-ISS Stage III ✓
- C R-ISS Stage II
- D Cannot be determined without FISH for t(14;16)
Correct answer: B. R-ISS Stage III
Explanation
The Revised International Staging System (R-ISS) for myeloma incorporates: ISS stage (based on beta-2 microglobulin and albumin), LDH, and FISH cytogenetics. R-ISS Stage III requires: ISS Stage III (beta-2 microglobulin ≥5.5 mg/L AND albumin <3.5 g/dL) plus either high-risk FISH [del(17p), t(4;14), t(14;16)] or elevated LDH. This patient has: ISS III (B2M 5.8, albumin 3.2), elevated LDH, AND high-risk cytogenetics [del(17p) and t(4;14)], confirming R-ISS Stage III with the worst prognosis (median OS ~29 months).
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.