R-ISS (Palumbo 2015)

R-ISS

Apply the Palumbo 2015 Revised International Staging System for multiple myeloma from ISS (beta-2 microglobulin and albumin), caller-assigned high-risk cytogenetic abnormalities, and LDH above the upper limit of normal.

LIVE $0.005 USDC GET /api/calc/r_iss

Markdown: /docs/r-iss.md · Canonical: https://magentlab.com/docs/r-iss

Not a medical device. Not a diagnosis, dose, or listing recommendation.

What it computes

When to use

When an agent has caller-supplied serum beta-2 microglobulin, albumin, high-risk iFISH CA, and LDH versus ULN and needs the published Palumbo 2015 R-ISS stage, not R2-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, albumin, LDH, or cytogenetics.
Not a myeloma diagnosis or treatment choice. This is Palumbo 2015 R-ISS only, not R2-ISS and not Durie-Salmon.
The caller assigns high_risk_ca (del(17p) and/or t(4;14) and/or t(14;16) by iFISH) and ldh_gt_uln (serum LDH > ULN). magent does not FISH or assign ULN.
This is not trauma ISS (Baker 1974 Injury Severity Score) and not Greipp 2005 ISS alone.

Formula

R-ISS I: ISS I AND high_risk_ca false AND ldh_gt_uln false; R-ISS III: ISS III AND (high_risk_ca OR ldh_gt_uln); R-ISS II: all other combinations. ISS I: beta2_microglobulin_mg_l < 3.5 AND albumin_g_dl >= 3.5; ISS III: beta2_microglobulin_mg_l >= 5.5; ISS II: neither I nor III (Palumbo 2015; ISS as Greipp 2005)

Citation

Title: Revised International Staging System for Multiple Myeloma: A Report From International Myeloma Working Group
Authors: Palumbo A, Avet-Loiseau H, Oliva S, et al.
Source: J Clin Oncol. 2015;33(26):2863-2869
DOI: 10.1200/JCO.2015.61.2267

Worked example

Beta-2 microglobulin 2.0 mg/L, albumin 4.0 g/dL, standard CA, normal LDH

Given: albumin_g_dl=4.0beta2_microglobulin_mg_l=2.0high_risk_ca=falseldh_gt_uln=false

Sβ2M 2.0 mg/L is < 3.5 and albumin 4.0 g/dL is >= 3.5 → ISS I
high_risk_ca is false and ldh_gt_uln is false
R-ISS I

ISS III with high-risk CA

Given: albumin_g_dl=4.0beta2_microglobulin_mg_l=6.0high_risk_ca=trueldh_gt_uln=false

Sβ2M 6.0 mg/L is >= 5.5 → ISS III; albumin is ignored
high_risk_ca is true
R-ISS III

Also searched as

R-ISS
revised ISS myeloma
Palumbo R-ISS
revised international staging system
multiple myeloma R-ISS
RISS
IMWG R-ISS
Palumbo 2015

Try

Opens the live endpoint. Unpaid browser requests show the paywall; agents should send Accept: application/json.

/api/calc/r_iss?beta2_microglobulin_mg_l=2.0&albumin_g_dl=4.0&high_risk_ca=false&ldh_gt_uln=false

Full URL: https://api.magentlab.com/api/calc/r_iss?beta2_microglobulin_mg_l=2.0&albumin_g_dl=4.0&high_risk_ca=false&ldh_gt_uln=false

Call

Expect HTTP 402 until you retry with PAYMENT-SIGNATURE. Incomplete query params return HTTP 400 before any quote or charge.

curl -i -H "Accept: application/json" "https://api.magentlab.com/api/calc/r_iss?beta2_microglobulin_mg_l=2.0&albumin_g_dl=4.0&high_risk_ca=false&ldh_gt_uln=false"

Parameters

Name	Type	Required	Description
`beta2_microglobulin_mg_l`	number	required	Serum beta-2 microglobulin in mg/L (0.2-40). Greipp 2005 / Palumbo 2015 ISS. 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. ISS uses 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.
`high_risk_ca`	boolean	required	High-risk cytogenetic abnormalities as assigned by the caller: true iff del(17p) and/or t(4;14) and/or t(14;16) by iFISH (Palumbo 2015). magent does not FISH.
`ldh_gt_uln`	boolean	required	Serum LDH greater than the upper limit of normal as assigned by the caller (Palumbo 2015: high LDH is > ULN). magent does not assay LDH or assign ULN.

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.

POST /api/calc/r_iss Max 25 unit_amount + extra_item_amount * (n - 1) extra $0.002 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 (fixture)

{
  "items": [
    {
      "albumin_g_dl": "4.0",
      "beta2_microglobulin_mg_l": "2.0",
      "high_risk_ca": "false",
      "ldh_gt_uln": "false"
    },
    {
      "albumin_g_dl": "4.0",
      "beta2_microglobulin_mg_l": "2.0",
      "high_risk_ca": "false",
      "ldh_gt_uln": "false"
    }
  ]
}

Open bulk paywall →

Opens a two-item fixture on the API host. Unpaid browsers get the same MetaMask paywall as GET; Pay retries POST with those items.

Example 200 (fixture)

{
  "count": 2,
  "path": "/api/calc/r_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": "Palumbo A, Avet-Loiseau H, Oliva S, et al.",
        "doi": "10.1200/JCO.2015.61.2267",
        "id": "palumbo-2015",
        "pmid": "26240224",
        "source": "J Clin Oncol. 2015;33(26):2863-2869",
        "title": "Revised International Staging System for Multiple Myeloma: A Report From International Myeloma Working Group"
      },
      "formula": "r_iss",
      "formula_expression": "R-ISS I: ISS I AND high_risk_ca false AND ldh_gt_uln false; R-ISS III: ISS III AND (high_risk_ca OR ldh_gt_uln); R-ISS II: all other combinations. ISS I: beta2_microglobulin_mg_l < 3.5 AND albumin_g_dl >= 3.5; ISS III: beta2_microglobulin_mg_l >= 5.5; ISS II: neither I nor III (Palumbo 2015; ISS as Greipp 2005)",
      "albumin_g_dl": 4.0,
      "beta2_microglobulin_mg_l": 2.0,
      "iss_stage": 1,
      "iss_stage_label": "I",
      "high_risk_ca": false,
      "ldh_gt_uln": false,
      "riss_stage": 1,
      "riss_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": "Palumbo A, Avet-Loiseau H, Oliva S, et al.",
        "doi": "10.1200/JCO.2015.61.2267",
        "id": "palumbo-2015",
        "pmid": "26240224",
        "source": "J Clin Oncol. 2015;33(26):2863-2869",
        "title": "Revised International Staging System for Multiple Myeloma: A Report From International Myeloma Working Group"
      },
      "formula": "r_iss",
      "formula_expression": "R-ISS I: ISS I AND high_risk_ca false AND ldh_gt_uln false; R-ISS III: ISS III AND (high_risk_ca OR ldh_gt_uln); R-ISS II: all other combinations. ISS I: beta2_microglobulin_mg_l < 3.5 AND albumin_g_dl >= 3.5; ISS III: beta2_microglobulin_mg_l >= 5.5; ISS II: neither I nor III (Palumbo 2015; ISS as Greipp 2005)",
      "albumin_g_dl": 4.0,
      "beta2_microglobulin_mg_l": 2.0,
      "iss_stage": 1,
      "iss_stage_label": "I",
      "high_risk_ca": false,
      "ldh_gt_uln": false,
      "riss_stage": 1,
      "riss_stage_label": "I"
    }
  ]
}

Response

Field	Type	Description
`formula`	string	r_iss
`formula_expression`	string	Palumbo 2015 R-ISS I / II / III from ISS plus high_risk_ca and ldh_gt_uln (ISS as Greipp 2005)
`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)
`high_risk_ca`	boolean	Caller-assigned high-risk iFISH CA (del(17p) and/or t(4;14) and/or t(14;16))
`ldh_gt_uln`	boolean	Caller-assigned serum LDH greater than the upper limit of normal
`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
`riss_stage`	integer	1, 2, or 3 (Palumbo 2015 R-ISS). Not Roman in this field.
`riss_stage_label`	string	I, II, or III matching riss_stage
`citation`	object	Palumbo 2015 J Clin Oncol citation
`disclaimer`	string	Not-a-device notice

Example JSON

Machine form of the same example. Frozen fixture. Not a live lookup.

{
  "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": "Palumbo A, Avet-Loiseau H, Oliva S, et al.",
    "doi": "10.1200/JCO.2015.61.2267",
    "id": "palumbo-2015",
    "pmid": "26240224",
    "source": "J Clin Oncol. 2015;33(26):2863-2869",
    "title": "Revised International Staging System for Multiple Myeloma: A Report From International Myeloma Working Group"
  },
  "formula": "r_iss",
  "formula_expression": "R-ISS I: ISS I AND high_risk_ca false AND ldh_gt_uln false; R-ISS III: ISS III AND (high_risk_ca OR ldh_gt_uln); R-ISS II: all other combinations. ISS I: beta2_microglobulin_mg_l < 3.5 AND albumin_g_dl >= 3.5; ISS III: beta2_microglobulin_mg_l >= 5.5; ISS II: neither I nor III (Palumbo 2015; ISS as Greipp 2005)",
  "albumin_g_dl": 4.0,
  "beta2_microglobulin_mg_l": 2.0,
  "iss_stage": 1,
  "iss_stage_label": "I",
  "high_risk_ca": false,
  "ldh_gt_uln": false,
  "riss_stage": 1,
  "riss_stage_label": "I"
}

Client errors (HTTP 400)

Invalid params return 400 without charge. Shared HTTP 402 and 503 meanings: Payments.

HTTP	Code	When
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.
400	`invalid_albumin`	albumin_g_dl (1-6) or albumin_g_l (10-60) is required Returned before settlement; you are not charged.
400	`invalid_flag`	boolean clinical flags must be true or false Returned before settlement; you are not charged.
400	`invalid_items`	POST body must be a JSON object with only an items array Returned before settlement; you are not charged.
400	`invalid_item_count`	items must be an array of 1 to 25 objects Returned before settlement; you are not charged.
400	`invalid_item`	each items entry must be a JSON object Returned before settlement; you are not charged.

Related tools

Myeloma ISS — Apply the Greipp 2005 International Staging System for multiple myeloma from serum beta-2 microglobulin and albumin.

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. Unpaid valid requests return HTTP 402 with a base64 PAYMENT-REQUIRED header. HTTP 503 is not a new quote: retry the same PAYMENT-SIGNATURE. Full handshake and shared payment errors: Payments. Stdio MCP: /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.