R2-ISSSecond Revised International Staging System

Official Myeloma Staging

Assign R2-ISS Stage

Note: R2-ISS is a composite score calculated from ISS stage (Beta-2 microglobulin/Albumin), LDH, and high-risk cytogenetics [del(17p), t(4;14), t(14;16), and 1q gain].

Integrated Result

R2-ISS I

Clinical Framing

Standard risk profile for R2-ISS Stage I.

Guidelines & Evidence

Verified

Last Review: 2026

When to Use

At the time of formal diagnosis of Active Multiple Myeloma.

Requires serum beta-2 microglobulin, albumin, LDH, and bone marrow FISH cytogenetics.

Used to define the risk of early relapse and overall survival, which dictates the necessity for aggressive triplet or quadruplet induction (e.g., Dara-VRd) and double-transplant or intensified maintenance strategies.

How it Works

Additive Scoring System

Variable	Points Assigned
ISS Stage II (Beta-2 microglobulin 3.5-5.5)	1.0
ISS Stage III (Beta-2 microglobulin > 5.5)	1.5
del(17p)	1.0
High LDH (> ULN)	1.0
t(4;14)	1.0
1q Amp/Gain	0.5

Risk Strata

Stage	Total Points	Median Progression-Free Survival
R2-ISS I	0 points	68 months
R2-ISS II	0.5 - 1.0 points	46 months
R2-ISS III	1.5 - 2.5 points	30 months
R2-ISS IV	3.0 - 5.0 points	19 months

Last Comprehensive Review: 2026

R2-ISSSecond Revised International Staging System

Official Myeloma Staging

Assign R2-ISS Stage

Note: R2-ISS is a composite score calculated from ISS stage (Beta-2 microglobulin/Albumin), LDH, and high-risk cytogenetics [del(17p), t(4;14), t(14;16), and 1q gain].

Integrated Result

R2-ISS I

Clinical Framing

Standard risk profile for R2-ISS Stage I.

Guidelines & Evidence

Verified

Last Review: 2026

When to Use

At the time of formal diagnosis of Active Multiple Myeloma.

Requires serum beta-2 microglobulin, albumin, LDH, and bone marrow FISH cytogenetics.

How it Works

Additive Scoring System

Variable	Points Assigned
ISS Stage II (Beta-2 microglobulin 3.5-5.5)	1.0
ISS Stage III (Beta-2 microglobulin > 5.5)	1.5
del(17p)	1.0
High LDH (> ULN)	1.0
t(4;14)	1.0
1q Amp/Gain	0.5

Risk Strata

Stage	Total Points	Median Progression-Free Survival
R2-ISS I	0 points	68 months
R2-ISS II	0.5 - 1.0 points	46 months
R2-ISS III	1.5 - 2.5 points	30 months
R2-ISS IV	3.0 - 5.0 points	19 months

Last Comprehensive Review: 2026

R2-ISS (Revised 2)

Official Myeloma Staging

R2-ISS I

When to Use

When to Use

How it Works

Additive Scoring System

Risk Strata

Clinical Pearls

The 1q Evolution

The Evidence

Key Reference

Second Revision of the International Staging System (R2-ISS) for Overall Survival in Multiple Myeloma

In Recent Clinical News

R2-ISS (Revised 2)

Official Myeloma Staging

R2-ISS I

When to Use

When to Use

How it Works

Additive Scoring System

Risk Strata

Clinical Pearls

The 1q Evolution

The Evidence

Key Reference

Second Revision of the International Staging System (R2-ISS) for Overall Survival in Multiple Myeloma

In Recent Clinical News