Clinical calculator summary
Myeloma R2-ISS and IMWG Frailty Panel
Clinical calculator summary
Myeloma R2-ISS and IMWG Frailty Panel
Strict parallel interpretation of original 2022 R2-ISS and original 2015 IMWG Frailty Score.
Evidence-based context for fast calculator use
- Purpose:
- Present disease-risk and frailty components without synthesizing treatment or a combined risk class.
- Population:
- Pretreatment newly diagnosed symptomatic multiple myeloma; frailty applies from age 65.
- Factors:
- B2M, Albumin, Local LDH status, del(17p), t(4;14), 1q gain/amplification, Age, ADL, IADL, CCI
- Reference:
- D’Agostino et al. JCO 2022; Palumbo et al. Blood 2015.
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Myeloma R2-ISS and IMWG Frailty Panel
mg/L
Enter a value greater than 0. Required only when calculating R2-ISS.
g/dL
Enter a value greater than 0. Required only when calculating R2-ISS.
Age determines whether the original IMWG Frailty Score applies. Below age 65, ADL, IADL, and CCI are not required.
Required for IMWG Frailty only when age is 65 years or older.
Required for IMWG Frailty only when age is 65 years or older.
Required for IMWG Frailty only when age is 65 years or older.
Clinical Context & Background
This panel reports two separate source-locked assessments for pretreatment newly diagnosed symptomatic multiple myeloma.
R2-ISS (2022) uses the verified original ISS foundation plus local LDH classification, del(17p), t(4;14), and 1q gain/amplification. Each cytogenetic result is represented separately. t(14;16) is not an R2-ISS score input or point. R2-ISS is reported as incomplete when any required LDH or cytogenetic result is unknown.
IMWG Frailty Score (2015) applies only from age 65 years and uses raw age, Katz ADL (0-6), Lawton IADL (0-8), and Charlson Comorbidity Index. Age 75 receives 0 points; age 76-80 receives 1 point; age over 80 receives 2 points.
The two components retain separate statuses, traces, endpoints, cohorts, and provenance. No combined category, treatment recommendation, transplant decision, dose adjustment, or regimen selection is produced. Published outcomes are cohort observations, not calibrated patient-specific predictions.
Formula Logic
Strict shared pretreatment contract with verified ISS foundation; original R2-ISS and IMWG Frailty components remain separate and are never averaged, ranked, or cross-classified.Reference Data
| Panel component | Source-locked output | Synthesis boundary |
|---|---|---|
| Component results | Each verified engine retains its own score, status, trace, cohort, and endpoint | No averaging, ranking, or merged clinical category |
| Unavailable component | Reported as unavailable or not applicable | Never converted to zero or a favorable result |
Clinical Workflow
Use, Interpret, And Continue The Patient Pathway
Expand for workflow guidance, limitations, examples, and related next steps.
Clinical Workflow
Use, Interpret, And Continue The Patient Pathway
Expand for workflow guidance, limitations, examples, and related next steps.
When To Use
- At pretreatment baseline after symptomatic multiple myeloma is newly diagnosed.
- When raw ISS laboratories and functional scores are explicitly available.
How To Interpret
- Treat R2-ISS incomplete as missing required disease-biology testing, not as standard risk.
- Treat frailty N/A below age 65 as outside the original panel scope, not as fit.
What To Do Next
- Integrate component results with the complete clinical assessment outside this calculator.
Limitations
- No combined score, model ranking, regimen, dose, transplant, maintenance, or treatment recommendation is generated.
- Cohort outcomes are not calibrated patient-specific predictions.
Validated Population
Implementation scope: pretreatment newly diagnosed symptomatic multiple myeloma.
Calculation verification history
Verified
Calculation verification history
Verified: Production browser revalidation
- Three source-backed production cases passed through visible controls across exact beta-2-microglobulin and age thresholds and the high-risk/frail endpoint.
- Observed independent results matched exactly: R2-ISS 0 / Stage I with IMWG Frailty 0 / Fit; R2-ISS 1 / Stage II with Frailty 1 / Intermediate fitness; and R2-ISS 5 / Stage IV with Frailty 5 / Frail.
- The published panel presents disease biology and patient frailty separately with no agreement/discordance synthesis, combined score, stale controls, literal undefined/null values, or visible error boundary.
Case-level production evidence is retained in validation/browser-revalidation/panel-myeloma-production-closure-2026-08-03.json.
: Local independent-component summary remediation
- Three visible-control cases covered the dual low-boundary profile, the exact beta-2-microglobulin/age transition, and the dual-maximum profile.
- The concise receipt now labels the second column `Independent result` and keeps R2-ISS disease biology separate from IMWG Frailty.
- All component scores and classifications matched; 840/840 assertions passed and the browser console was clean.
Case evidence is retained in validation/browser-revalidation/panel-myeloma-local-remediation-2026-08-03.json.
: Production browser revalidation — UI finding retained
- Three source-backed dual-component cases matched the independent R2-ISS and IMWG Frailty expected results at low, exact threshold-transition, and maximum profiles.
- Production still labels the panel summary `RESULT / AGREEMENT` and instructs users to `review agreement or discordance clinically`, outside the neutral parallel-results contract.
- Overall production status remains failed-ui-safety until that residual synthesis wording is removed and revalidated; no browser-console error was observed.
Case-level evidence and reproduction are retained in validation/browser-revalidation/panel-myeloma-2026-08-03.json.
: Local browser remediation verified; production retest pending
- Ten source-backed cases passed through visible controls on the corrected local route across 11 submissions.
- R2-ISS and IMWG frailty remained separate across thresholds, component-only, incomplete, not-applicable, outside-scope, and reset/repeat paths.
- No unified score, combined assessment, agreement/discordance synthesis, ranking, or cross-classification was displayed. The original production findings remain open until deployment and public revalidation.
Case-level local remediation evidence is retained in validation/browser-production/panel-myeloma.local-remediation.json.
: Production browser validation
- Ten source-backed cases were exercised on the public production route through visible browser controls; 1/10 case records passed their expected-versus-observed assertions across 11 visible submissions.
- Overall browser status: failed-ui-safety-and-console. critical: All nine rendered component-result cases were headed `Unified Panel Results`, described as a `Combined assessment from multiple tools`, and instructed users to compare `agreement and discordance alongside the unified panel result`. | medium: Production emitted minified React error #418 during route loads/reloads used by this run.
- Case-level inputs, expected and observed results, reset/repeat behavior, failure reproductions, and console evidence are retained in the production-browser evidence record.
Case-level production evidence is retained in validation/browser-production/panel-myeloma.json.
: Exact input guidance for unavailable components
- Revised International Staging System and International Myeloma Working Group Frailty explanations now expand model names, use "Please review", and identify exact visible entries in parentheses.
- Unknown disease-biology results point back to their specific testing controls.
- No score, stage, threshold, outcome, or component-isolation behavior changed.
All 840 existing panel assertions pass; current report remains applicable.
: Input-quality and partial-completion verification
- Added panel guidance and explicit component-dependency labels for all 12 fields; diagnosis and assessment timing remain required shared scope gates, while the six R2-ISS and four Frailty inputs are optional at panel level.
- Blank component groups now return Skipped, partial or malformed component groups return Invalid Input, and either state preserves a valid sibling result.
- Patients younger than 65 now receive the source-defined Frailty Not applicable result from age alone without entering ADL, IADL, or CCI.
- Guarded UI serialization normalizes canonical numeric strings without converting blank values to zero; B2M and albumin are restricted to values greater than zero before calculation.
- All 840/840 deterministic assertions passed with unchanged source formulas, thresholds, outcomes, scope, and no-combined-result boundary.
: Full validation test
- 840/840 source, strict-contract, ISS-parity, exhaustive R2-ISS, R2 outcome, exhaustive frailty, frailty boundary, sibling-isolation, orchestration, provenance, history, report, and evidence assertions passed.
- This is implementation verification, not independent clinical validation; component cohort outcomes remain separate observations.
: Correction
- Locked the panel to original 2022 R2-ISS and original 2015 IMWG Frailty Score with verified ISS foundation and strict 12-key input validation.
- Separated del(17p), t(4;14), and 1q; removed t(14;16), defaults, coercion, age-75 error, unknown-as-absent behavior, pre-scored functional inputs, mixed highlighting, and treatment/transplant synthesis.
: ISS foundation semantics verified
- 48/48 projections confirmed that the panel uses the same exact original ISS B2M and albumin thresholds as the R-ISS engine.
- This historical component event preceded complete R2-ISS, frailty, and panel verification.
Verification confirms the calculator implementation against the cited model; it is not independent clinical validation, regulatory approval, or medical advice.
Related Tools
Frequently Asked Questions
When should Myeloma R2-ISS and IMWG Frailty Panel be used?
Use it for patients whose clinical question requires the component models displayed in the combined panel when all required inputs and the intended clinical setting are confirmed.
Can Myeloma R2-ISS and IMWG Frailty Panel determine treatment by itself?
No. Interpret the result with the cited evidence, complete clinical assessment, current guidelines, and patient-specific goals.
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