The clinical presentation of multiple myeloma (MM) often includes bone pain, anemia, renal dysfunction, hypercalcemia, and/or constitutional symptoms such as fever, fatigue, and malaise. There are no signs or symptoms that are disease-specific. The International Staging System (ISS) stratifies patients for prognostic purposes based on an assessment of beta 2-microglobulin and albumin levels. However, the degree to which whether ISS stage is associated with disease or symptom burden is unclear.
This study used data from the longitudinal CoMMpass trial led by the Multiple Myeloma Research Foundation. CoMMpass collects relevant clinical data and patient-reported quality-of-life information, as well as sequential tissue samples. Disease stage was subsequently calculated by the analysts for this study according to the ISS.1
A total of 599 patients were eligible for the analysis; the mean age for ISS stage III was 67 years, 65 years for stage II, and 61 years for stage I (P <.001). Compared with stage I and II patients, stage III patients had higher serum M-proteins (P <.001), lactate dehydrogenase (P = .039), bone marrow plasma cells (P <.001), calcium (P <.001), and creatinine (P <.001), as well as lower hemoglobin (P <.001) and platelets (P = .001). Stage III patients also had poorer performance status (P <.001), global health (P <.001), physical functioning (P <.001), social functioning (P <.001), and role functioning (P <.001), and increased fatigue (P <.001) and pain (P = .016). Stage I and II patients were statistically similar in all measures of disease burden except bone lesions.
Based on these findings, researchers concluded that ISS may not discriminate well between stage I and II patients. These findings are consistent with prior analyses that have failed to find outcomes differences between stage I and II patients
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