The first staging system for MM was proposed in 1975 ( 1) followed by the development of the International Staging System (ISS) ( 2) in 2005 and a Revised ISS (R-ISS) ( 3) in 2015. These risk groups further assist in identifying high-risk patients who may require intense therapy upfront and/or a higher monitoring frequency during the follow-up periods. Multiple prognostic systems ( 1– 5) have been described in MM that stratify patients into different risk groups. Substantial advances in tumor biology have made it possible to dissect the tumor heterogeneity present in MM, optimize patient treatment, and examine patient outcome. The variability in the outcome of patients is an implication of the clinical and biological heterogeneity underlying multiple myeloma (MM). Multiple myeloma is a hematopoietic malignancy of plasma cells with an overall survival period ranging from 6 months to more than 10 years.
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