R-ISS (Multiple Myeloma)

Revised International Staging System — β2-microglobulin, albumin, LDH and FISH cytogenetics

Serum β2-microglobulin (mg/L)

Serum albumin (g/dL)

Serum LDH

Normal (≤ the upper limit of normal)

Elevated (> the upper limit of normal)

High-risk FISH cytogenetics — del(17p), t(4;14) or t(14;16)

None present (standard risk)

At least one present (high risk)

Enter β2-microglobulin and albumin to calculate

Evidence

Original publication

Palumbo A, Avet-Loiseau H, Oliva S, et al. Revised International Staging System for multiple myeloma: a report from the International Myeloma Working Group. Combined the ISS (β2-microglobulin and albumin) with serum LDH and high-risk FISH cytogenetics [del(17p), t(4;14), t(14;16)]; 5-year overall survival was 82%, 62% and 40% for R-ISS I, II and III.

Journal of Clinical Oncology, 2015

Open source

Guideline

The R-ISS is the standard prognostic stage for newly diagnosed multiple myeloma in NCCN and ESMO guidance. Newer models (R2-ISS, adding 1q21 gain/amplification, and the IMS 2024 framework) refine risk further but the R-ISS remains widely used.

Last reviewed: 2026-09

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