Multiple myeloma with ISS stage 1 — β2-microglobulin <3.5 mg/L AND albumin ≥3.5 g/dL — st...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

ID	`RF-ISS-1`
Type	Red flag
Status	reviewed 2026-04-27 \| pending_clinical_signoff
Diseases	`DIS-MM`
Sources	`SRC-ESMO-MM-2023` `SRC-NCCN-MM-2025`

Red Flag Origin

Definition	Multiple myeloma with ISS stage 1 — β2-microglobulin <3.5 mg/L AND albumin ≥3.5 g/dL — standard-risk presentation; eligible for standard 1L (D-VRd transplant-eligible / D-Rd unfit) without intensification beyond the four-drug baseline
Clinical direction	de-escalate
Category	risk-score
Shifts algorithm	ALGO-MM-1L

Trigger Logic

{
  "all_of": [
    {
      "comparator": "<",
      "finding": "beta2_microglobulin_mg_per_l",
      "threshold": 3.5
    },
    {
      "comparator": ">=",
      "finding": "serum_albumin_g_per_dl",
      "threshold": 3.5
    }
  ],
  "type": "composite_score"
}

Notes

ISS (Greipp 2005) is the original 3-tier MM staging using β2M and albumin only. ISS-1 (β2M <3.5 + albumin ≥3.5) = median OS ~62 mo in the original cohort and substantially longer in the modern era with daratumumab-based 1L (PERSEUS / IsKia / GRIFFIN show D-VRd 4-yr PFS ~85% in ISS-1). de-escalate direction means "do not add cytogenetic- driven intensification beyond D-VRd baseline" — high-risk cytogenetics override this if present (handled by separate biomarker RFs).

Used By

Algorithms

ALGO-MM-1L - ALGO-MM-1L