A 58-year-old man with multiple myeloma is being evaluated for autologous stem cell transplant eligibility. He has no significant comorbidities. Serum M-protein is 3.8 g/dL (IgG kappa), bone marrow plasma cells 55%, and serum free light chain ratio is abnormal. LDH is normal. Serum beta-2 microglobulin is 5.2 mg/L and albumin is 3.0 g/dL. FISH shows t(4;14) translocation. According to the Revised ISS (R-ISS), what stage is this myeloma?
- A R-ISS Stage II (intermediate risk)
- B R-ISS Stage I (low risk)
- C Cannot stage without del(17p) and t(14;16) results
- D R-ISS Stage III (high risk) ✓
Explanation
The R-ISS (Revised ISS, 2015) stages myeloma using three criteria: ISS stage, serum LDH, and cytogenetic risk. ISS stage is determined by beta-2 microglobulin and albumin: ISS Stage III requires beta-2M ≥ 5.5 mg/L and/or albumin < 3.5 g/dL; this patient has beta-2M 5.2 (borderline) and albumin 3.0 (< 3.5), meeting Stage III ISS. R-ISS Stage III = ISS Stage III AND (LDH elevated OR high-risk cytogenetics [del(17p), t(4;14), or t(14;16)]). This patient has ISS Stage III and t(4;14) — a high-risk cytogenetic finding — making this R-ISS Stage III. R-ISS Stage I requires ISS Stage I + normal LDH + standard cytogenetics.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.