# Myeloma ISS (Greipp 2005) Myeloma ISS Status: LIVE Price: $0.005 USDC `GET /api/calc/myeloma_iss` HTML: https://magentlab.com/docs/myeloma-iss Markdown: https://magentlab.com/docs/myeloma-iss.md Not a medical device. Not a diagnosis, dose, or listing recommendation. ## What it computes Apply the Greipp 2005 International Staging System for multiple myeloma from serum beta-2 microglobulin and albumin. ## When to use When an agent has caller-supplied serum beta-2 microglobulin (mg/L) and albumin and needs the published Greipp 2005 ISS stage, not R-ISS, not Durie-Salmon, and not a treatment recommendation. ## When not to use - Not a medical device. magent does not examine the patient and does not assay beta-2 microglobulin or albumin. - Not a myeloma diagnosis or treatment choice. This is Greipp 2005 ISS only, not R-ISS (no LDH, no cytogenetics) and not Durie-Salmon. - This is not trauma ISS (Baker 1974 Injury Severity Score). ## Formula ``` ISS stage I: beta2_microglobulin_mg_l < 3.5 AND albumin_g_dl >= 3.5; stage III: beta2_microglobulin_mg_l >= 5.5; stage II: neither I nor III (Greipp 2005) ``` ## Citation [International staging system for multiple myeloma](https://doi.org/10.1200/JCO.2005.04.242) Greipp PR, San Miguel J, Durie BGM, Crowley JJ, Barlogie B, Bladé J, Boccadoro M, Child JA, Avet-Loiseau H, Kyle RA, Lahuerta JJ, Ludwig H, Morgan G, Powles R, Shimizu K, Shustik C, Sonneveld P, Tosi P, Turesson I, Westin J J Clin Oncol. 2005;23(15):3412-3420 DOI: [10.1200/JCO.2005.04.242](https://doi.org/10.1200/JCO.2005.04.242) ## Worked example ### Beta-2 microglobulin 2.0 mg/L, albumin 4.0 g/dL Given: `albumin_g_dl=4.0, beta2_microglobulin_mg_l=2.0` 1. Sβ2M 2.0 mg/L is < 3.5 and albumin 4.0 g/dL is >= 3.5 2. Stage I ### Beta-2 microglobulin 6.0 mg/L with albumin 4.0 g/dL Given: `albumin_g_dl=4.0, beta2_microglobulin_mg_l=6.0` 1. Sβ2M 6.0 mg/L is >= 5.5 2. Stage III; albumin is ignored ## Also searched as - ISS myeloma - Greipp ISS - international staging system - multiple myeloma staging - ISS 2005 - serum beta-2 microglobulin ISS - myeloma ISS stage - Greipp 2005 ISS ## Parameters - `beta2_microglobulin_mg_l` (number, required): Serum beta-2 microglobulin in mg/L (0.2-40). Greipp 2005 Sβ2M. Stage I requires < 3.5; stage III when >= 5.5. magent does not assay beta-2 microglobulin. - `albumin_g_dl` (number, optional): Serum albumin in g/dL (1-6). Provide this or albumin_g_l, not both. Greipp 2005 stages use g/dL. Stage I requires albumin >= 3.5 when Sβ2M < 3.5. Ignored when Sβ2M >= 5.5. - `albumin_g_l` (number, optional): Serum albumin in g/L (10-60). Converted as g/dL = g/L / 10. Provide this or albumin_g_dl, not both. ## Bulk (POST) POST the same path with a JSON items array. The first item is the GET unit; each additional item is $0.002. Invalid items return HTTP 400 before settlement. Method: `POST /api/calc/myeloma_iss` Max items: 25 Price: unit_amount + extra_item_amount * (n - 1) (unit 5000 atomic, extra 2000 atomic) Status: PREVIEW - 1 to 25 items. Each item uses the same keys as the GET query parameters. - POST of 1 item costs the same as GET. Lists longer than 25: chunk into multiple POSTs. Extra items still execute; do not pad dummy rows. - The first invalid item fails the whole request (index in the 400 JSON). You are not charged. - HTTP 200 is {count, path, items}. Each items[i] is the GET 200 body for that row. - Catalog misses (empty matches, found=false) stay paid 200s inside that slot. - x402 resource URL is this path plus n and body_sha256. Browsers that prefer text/html get the same paywall as GET; Pay retries POST with the same items. Example request: ```json { "items": [ { "albumin_g_dl": "4.0", "beta2_microglobulin_mg_l": "2.0" }, { "albumin_g_dl": "4.0", "beta2_microglobulin_mg_l": "2.0" } ] } ``` Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/myeloma-iss Example 200: ```json { "count": 2, "path": "/api/calc/myeloma_iss", "items": [ { "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.", "citation": { "authors": "Greipp PR, San Miguel J, Durie BGM, Crowley JJ, Barlogie B, Bladé J, Boccadoro M, Child JA, Avet-Loiseau H, Kyle RA, Lahuerta JJ, Ludwig H, Morgan G, Powles R, Shimizu K, Shustik C, Sonneveld P, Tosi P, Turesson I, Westin J", "doi": "10.1200/JCO.2005.04.242", "id": "greipp-2005", "pmid": "15809451", "source": "J Clin Oncol. 2005;23(15):3412-3420", "title": "International staging system for multiple myeloma" }, "formula": "myeloma_iss", "formula_expression": "ISS stage I: beta2_microglobulin_mg_l < 3.5 AND albumin_g_dl >= 3.5; stage III: beta2_microglobulin_mg_l >= 5.5; stage II: neither I nor III (Greipp 2005)", "albumin_g_dl": 4.0, "beta2_microglobulin_mg_l": 2.0, "iss_stage": 1, "iss_stage_label": "I" }, { "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.", "citation": { "authors": "Greipp PR, San Miguel J, Durie BGM, Crowley JJ, Barlogie B, Bladé J, Boccadoro M, Child JA, Avet-Loiseau H, Kyle RA, Lahuerta JJ, Ludwig H, Morgan G, Powles R, Shimizu K, Shustik C, Sonneveld P, Tosi P, Turesson I, Westin J", "doi": "10.1200/JCO.2005.04.242", "id": "greipp-2005", "pmid": "15809451", "source": "J Clin Oncol. 2005;23(15):3412-3420", "title": "International staging system for multiple myeloma" }, "formula": "myeloma_iss", "formula_expression": "ISS stage I: beta2_microglobulin_mg_l < 3.5 AND albumin_g_dl >= 3.5; stage III: beta2_microglobulin_mg_l >= 5.5; stage II: neither I nor III (Greipp 2005)", "albumin_g_dl": 4.0, "beta2_microglobulin_mg_l": 2.0, "iss_stage": 1, "iss_stage_label": "I" } ] } ``` ## Response fields - `formula` (string): myeloma_iss - `formula_expression` (string): Greipp 2005 ISS stage I / II / III rules in paper units (mg/L and g/dL) - `beta2_microglobulin_mg_l` (number): Serum beta-2 microglobulin used in mg/L - `albumin_g_dl` (number): Serum albumin used in g/dL (after g/L conversion when supplied) - `iss_stage` (integer): 1, 2, or 3 (Greipp 2005 ISS). Not Roman in this field. - `iss_stage_label` (string): I, II, or III matching iss_stage - `citation` (object): Greipp 2005 J Clin Oncol citation - `disclaimer` (string): Not-a-device notice ## Example JSON Frozen fixture. Not a live lookup. ```json { "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.", "citation": { "authors": "Greipp PR, San Miguel J, Durie BGM, Crowley JJ, Barlogie B, Bladé J, Boccadoro M, Child JA, Avet-Loiseau H, Kyle RA, Lahuerta JJ, Ludwig H, Morgan G, Powles R, Shimizu K, Shustik C, Sonneveld P, Tosi P, Turesson I, Westin J", "doi": "10.1200/JCO.2005.04.242", "id": "greipp-2005", "pmid": "15809451", "source": "J Clin Oncol. 2005;23(15):3412-3420", "title": "International staging system for multiple myeloma" }, "formula": "myeloma_iss", "formula_expression": "ISS stage I: beta2_microglobulin_mg_l < 3.5 AND albumin_g_dl >= 3.5; stage III: beta2_microglobulin_mg_l >= 5.5; stage II: neither I nor III (Greipp 2005)", "albumin_g_dl": 4.0, "beta2_microglobulin_mg_l": 2.0, "iss_stage": 1, "iss_stage_label": "I" } ``` ## Errors - HTTP 400 `invalid_beta2_microglobulin`: beta2_microglobulin_mg_l must be a number from 0.2 to 40 (Greipp 2005 ISS). Returned before settlement; you are not charged. - HTTP 400 `invalid_albumin`: albumin_g_dl (1-6) or albumin_g_l (10-60) is required Returned before settlement; you are not charged. - HTTP 400 `invalid_items`: POST body must be a JSON object with only an items array Returned before settlement; you are not charged. - HTTP 400 `invalid_item_count`: items must be an array of 1 to 25 objects Returned before settlement; you are not charged. - HTTP 400 `invalid_item`: each items entry must be a JSON object Returned before settlement; you are not charged. Shared HTTP 402 and 503: https://magentlab.com/docs/payments ## Related tools - [IMDC](https://magentlab.com/docs/imdc) — Sum the Heng 2009 IMDC adverse factors for metastatic RCC treated with VEGF-targeted agents and return favorable (0), intermediate (1–2), or poor (3–6). Heng 2009 reported 2-year OS 75% (median not reached), 53% (median 27 months), and 7% (median 8.8 months) in those groups. - [FLIPI](https://magentlab.com/docs/flipi) — Sum the Solal-Céligny 2004 FLIPI adverse factors for follicular lymphoma and return low (0–1), intermediate (2), or high (≥3). ## Payment Unpaid requests return HTTP 402 even if query parameters or POST items are missing or invalid, so CDP and agents can index the path. After a PAYMENT-SIGNATURE, invalid params return HTTP 400 JSON before settlement. magent does not charge. Fix the params, then request a new 402 quote for that complete URL. Catalog misses (empty matches, found=false) are valid paid 200s. - GET the tool with Accept: application/json (do not send Accept: text/html unless you want the human paywall). - HTTP 402 means you have not paid. Decode the base64 PAYMENT-REQUIRED header. HTTP 503 is not a new quote. - Sign accepts[0] (exact, EIP-3009) with validBefore = now + maxTimeoutSeconds (600 seconds), or accepts[1] (batch-settlement deposit/voucher) on product GET. Ping and POST {items} stay exact. Magent retries transient facilitator 429/5xx before answering. - Retry the same URL with PAYMENT-SIGNATURE (base64 JSON of accepted and payload). Magent attaches canonical extensions.bazaar on CDP verify/settle; echoing 402 bazaar is optional. - Success is HTTP 200 JSON plus PAYMENT-RESPONSE. exact settles before the tool. batch-settlement verifies (and deposit-settles) before the tool and commits the charge after HTTP 2xx. HTTP 503: retry the same PAYMENT-SIGNATURE. Mint a new exact nonce only after a new HTTP 402. - offered `exact` on eip155:8453: Fixed-price USDC on Base. The buyer authorizes the advertised amount (EIP-3009). magent settles before the tool runs (paymentFlow upfront). extra.assetTransferMethod=eip3009 extra.paymentFlow=upfront. - offered `batch-settlement` on eip155:8453: Payment-channel vouchers claimed later in batches. Exact stays accepts[0]. Same-path POST {items} is still exact. extra.assetTransferMethod=eip3009 extra.paymentFlow=authorization. - not offered `upto`: Not offered. Usage-based: buyer authorizes a ceiling, seller settles the actual amount after work. Reserved for a future metered tool. Not for current calculators or code search. Same-path POST {items} is still scheme exact: one EIP-3009 authorization for GET unit plus $0.002 per extra item. That is not x402 batch-settlement (payment channels / vouchers). Shared HTTP 402 and 503 table: https://magentlab.com/docs/payments Stdio MCP (one process per host): https://magentlab.com/docs/mcp ## Guarantees - HTTP 402 is unpaid, including a missing query. After PAYMENT-SIGNATURE, invalid parameters return HTTP 400 before settlement. You are not charged. - exact: settlement finishes before the tool (paymentFlow upfront). batch-settlement: verify/deposit before the tool; chargedCumulativeAmount commits after HTTP 2xx. Uncertain or failed settlement fails closed (HTTP 503). Retry the same PAYMENT-SIGNATURE. - HTTP 402 is unpaid only. Do not sign a second authorization because of a 503. - Execution is timeout-bounded and concurrency-capped. - Calculator inputs are stored encrypted for allowlisted operators (Magent Console). They are not in public logs, SSH lookups, catalog, or rollups. Request logs store path without query.