Highlights
- •The ISS combines concentrations of albumin and beta-2 microglobulin.
- •The ISS may be a prognostic staging system unspecific of MM.
- •Older adults with abnormal ISS had 44%-shorter survival time over 17 years.
- •The ISS may serve as a potent prognostic marker in the general senior population.
Abstract
The International Staging System (ISS) -calculated from serum albumin and beta-2 microglobulin
(β2m)- is an established prognostic marker in multiple myeloma (MM), which has also
been suggested to account for survival among general senior population. Our objective
was to examine long-term survival of older women free of MM according to baseline
ISS. The study included 230 community-dwelling healthy older women without known MM
from the EPIDOS cohort (mean ± SD, 80.4 ± 3.4 years). Serum albumin and β2m were measured
at baseline, and used to calculate the ISS a posteriori. Abnormal ISS was defined as ISS = 2 or ISS = 3, although ISS = 1 was considered
normal. The vital status was sought after a mean follow-up of 17.6 ± 0.2 years (range,
16.8–18.3). Age, body mass index, mean arterial pressure, diabetes mellitus, hypertension,
coronary heart disease, stroke, use corticosteroids, number of drugs daily taken,
smoking, physical activity, fall history, bone mineral density, and creatinine clearance
were used as potential confounders. All participants died during the 17-year follow-up.
Compared to women with normal ISS, those with abnormal ISS (n = 24) had shorter survival time (4.9 ± 4.3 versus 8.7 ± 5.2 years, P = .001) and died earlier (85.6 ± 4.8 versus 89.1 ± 5.6 years old, P = .003). Survival time after blood test correlated with both serum albumin (r = 0.16, P = .015) and β2m (r = −0.27, P < .001). Cox regression revealed that abnormal ISS was associated with mortality
(adjusted HR = 3.03, P < .001). Kaplan-Meier distributions showed that participants with abnormal ISS died
earlier than those with normal ISS (log-rank P < .001). In conclusion, community-dwelling older women with abnormal ISS had shorter
survival time than the others, suggesting that ISS could be considered as a universal
prognostic “aging system” rather than a specific MM “staging system”.
Keywords
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Article info
Publication history
Published online: August 03, 2019
Accepted:
July 30,
2019
Received in revised form:
July 25,
2019
Received:
April 10,
2019
Identification
Copyright
© 2019 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
