The role of staging in multiple myeloma

ABSTRACT

Introduction

The importance of cancer staging is determined by how accurately it can predict prognosis, and how useful it is for treatment decisions. Compared to other malignancies, multiple myeloma (MM) staging proved more challenging because of unreliable prognostic factors and wide-ranging life expectancy. As traditional MM staging continues to evolve, it requires reassessment of its prognostic and predictive value.

Areas covered

The studies that included prognostic and predictive value of MM stages from 1975 through 2023 were selected for this review using PubMed, MEDLINE platforms. The history and evolution of MM staging are revisited, including its role in predicting survival, treatment planning and potential practical implications for the future. The role of MM staging for oncological practice and patient counseling is discussed.

Expert opinion

The utility of the traditional MM staging remains unsatisfactory because it lacks a strong connection with the disease biology, prognosis or treatment planning. Additionally, it demonstrates a modest value for patient counseling because individual prognosis is subject to under- or overestimation, and the median survival or survival rates are difficult concepts to grasp. Although the role of MM stages may change in the future, the current research upholds the notion that MM staging benefits more medical research and clinical trials than oncological practice.

KEYWORDS:

• Multiple myeloma
• staging
• risk stratification
• prognosis
• treatment

Article highlights

• The utility of the traditional MM staging remains unsatisfactory because it lacks a strong connection with the disease biology and prognosis.

• Traditional MM stage assignment remains challenging in the absence of reliable prognostic criteria. Even when assigned correctly, the MM stages cannot guarantee accurate prediction of survival.

• Traditional MM staging is immaterial to and, therefore, unsuitable for treatment planning including eligibility (recommendations) for stem cell transplantation.

• Traditional MM staging demonstrates a modest value for patient counseling because the median survival or survival rates are difficult concepts to grasp, and individual prognosis is subject to under- or overestimation.

• The replacement of traditional MM staging with advanced risk stratification tools should benefit medical research and clinical trials.

List of abbreviations

MM	=	multiple myeloma
B2M	=	beta 2-microglobulin
LDH	=	lactate dehydrogenase
DSS	=	Durie-Salmon Staging
ISS	=	International Staging System
R-ISS	=	Revised International Staging System
FISH	=	fluorescence in situ hybridization
OS	=	overall survival
PFS	=	progression free survival
PET	=	positron emission tomography
CT	=	computed tomography
ASCT	=	autologous stem cell transplant

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.