# R-ISS (Palumbo 2015)

R-ISS

Status: LIVE
Price: $0.005 USDC
`GET /api/calc/r_iss`
HTML: https://magentlab.com/docs/r-iss
Markdown: https://magentlab.com/docs/r-iss.md

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

## What it computes

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.

## 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

[Revised International Staging System for Multiple Myeloma: A Report From International Myeloma Working Group](https://doi.org/10.1200/JCO.2015.61.2267)
Palumbo A, Avet-Loiseau H, Oliva S, et al.
J Clin Oncol. 2015;33(26):2863-2869
DOI: [10.1200/JCO.2015.61.2267](https://doi.org/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=4.0, beta2_microglobulin_mg_l=2.0, high_risk_ca=false, ldh_gt_uln=false`

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


### ISS III with high-risk CA

Given: `albumin_g_dl=4.0, beta2_microglobulin_mg_l=6.0, high_risk_ca=true, ldh_gt_uln=false`

1. Sβ2M 6.0 mg/L is >= 5.5 → ISS III; albumin is ignored
2. high_risk_ca is true
3. 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

## Parameters

- `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.

Method: `POST /api/calc/r_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",
      "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"
    }
  ]
}
```

Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/r-iss

Example 200:

```json
{
  "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 fields

- `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

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": "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"
}
```

## 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_flag`: boolean clinical flags must be true or false 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

- [Myeloma ISS](https://magentlab.com/docs/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.

- 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.