R-ISS (Revised ISS)

R-ISS (Revised ISS): The modern gold standard for Myeloma staging. Integrates ISS, FISH genetics, and LDH status.

ISS Baseline

FISH Cytogenetics

LDH Level

Revised Clinical Stage (R-ISS)

—

Select ISS group, Genetics, and LDH status to determine Revised Stage.

Guidelines & Evidence

Verified

Last Review: 2026-07-17

When to Use

Baseline staging of newly diagnosed Multiple Myeloma in the modern era.

Integrating clinical biomarkers (ISS) with genomic (FISH) and metabolic (LDH) risk factors.

Providing the most accurate prediction of overall and progression-free survival.

Patient Population

Adult patients with newly diagnosed, symptomatic Multiple Myeloma.

When Not to Rely on This Score Alone

Patients without FISH data — standard ISS must be used instead.

Age-specific considerations — while R-ISS is robust, patient fitness (e.g., IMWG Frailty Index) is equally important for therapy selection.

R2-ISS — for even more granular genomic integration (including 1q gain), newer updates like R2-ISS may be preferred in clinical trials.

How it Works

Criteria

Stage	Definition
I	ISS Stage I AND Standard-risk FISH AND Normal LDH
III	ISS Stage III AND (High-risk FISH OR High LDH)
II	Neither Stage I nor Stage III

What is High-risk FISH?

del(17p)

t(4;14)

t(14;16)

Estimated 5-y OS

Stage	Overall Survival (%)
I	82%
II	62%
III	40%

Last Comprehensive Review: 2026-07-17

In Recent Clinical News

Scanning Medical Journals

No new significant updates or guidelines matching this topic were found today. We will check again soon.

R-ISS (Revised ISS)

ISS Baseline

FISH Cytogenetics

LDH Level

—

When to Use

When to Use

Patient Population

When Not to Rely on This Score Alone

How it Works

Criteria

What is High-risk FISH?

Estimated 5-y OS

Clinical Pearls

The Paradigm Shift

The Evidence

Primary Score

Revised International Staging System for Multiple Myeloma: A Report From International Myeloma Working Group.

Origins & History

Consensus

In Recent Clinical News

R-ISS (Revised ISS)

ISS Baseline

FISH Cytogenetics

LDH Level

—

When to Use

When to Use

Patient Population

When Not to Rely on This Score Alone

How it Works

Criteria

What is High-risk FISH?

Estimated 5-y OS

Clinical Pearls

The Paradigm Shift

The Evidence

Primary Score

Revised International Staging System for Multiple Myeloma: A Report From International Myeloma Working Group.

Origins & History

Consensus

In Recent Clinical News