Multiple Myeloma: ISS and R-ISS

Multiple Myeloma staging: International Staging System (ISS) and the R-ISS

ISS stage
Serum b2M < 3.5 mg/L, serum albumin >/=3.5 g/dL
II Not ISS stage I or III
III Serum b2M >/= 5.5 mg/L
High risk Presence of del(17p) and/or translocation t(4;14) and/or translocation t(14;16)
Standard risk No high-risk CA
Normal Serum LDH < the upper limit of normal
High Serum LDH > the upper limit of normal
R-ISS stage R-ISS stage is based on ISS stage + FISH findings+ LDH
I ISS stage I and standard-risk CA by iFISH and normal LDH
II Not R-ISS stage I or III
III ISS stage III and either high-risk CA by iFISH or high LDH


  • Greipp PR, San Miguel J, Durie BG et al. International staging system for multiple myeloma. J Clin Oncol 2005; 23: 3412–3420
  • Palumbo A, Avet-Loiseau H, Oliva S et al. Revised international stagingbsystem for multiple myeloma: a report from International Myeloma Working Group. J Clin Oncol 2015; 33: 2863–2869.