Multiple myeloma staging: Difference between revisions
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{{Multiple myeloma}} | {{Multiple myeloma}} | ||
{{CMG}} | {{CMG}} {{AE}} {{HMHJ}}; {{HL}}; {{shyam}} | ||
==Overview== | ==Overview== | ||
Multiple myeloma may be divided into three stages based on either the International Staging System or Durie-Salmon Staging System.<ref>About multiple myeloma. University of California San Francisco (2015)http://cancer.ucsf.edu/research/multiple-myeloma/ Accessed on September, 18 2015 </ref> The International Staging System for multiple myeloma was published by International Myeloma Working Group in 2003 and is the most widely used staging system.<ref name="ISS">Greipp PR, San Miguel J, Fonseca R, Avet-Loiseau H, Jacobson JL, Rasmussen E, Crowley J, Durie BMG. Development of an international prognostic index (IPI) for myeloma: report of the international myeloma working group. ''Hematology Journal'' 2003;4:S42. NLM ID 100965523. | [[Multiple myeloma]] may be divided into three stages based on either the International Staging System (ISS) or Durie-Salmon Staging System.<ref name="California">About multiple myeloma. University of California San Francisco (2015)http://cancer.ucsf.edu/research/multiple-myeloma/ Accessed on September, 18 2015 </ref> The International Staging System for [[multiple myeloma]] was published by the '''International Myeloma Working Group''' in 2003 and is the most widely used staging system.<ref name="California">About multiple myeloma. University of California San Francisco (2015)http://cancer.ucsf.edu/research/multiple-myeloma/ Accessed on September, 18 2015 </ref><ref name="ISS">Greipp PR, San Miguel J, Fonseca R, Avet-Loiseau H, Jacobson JL, Rasmussen E, Crowley J, Durie BMG. Development of an international prognostic index (IPI) for myeloma: report of the international myeloma working group. ''Hematology Journal'' 2003;4:S42. NLM ID 100965523.</ref> It is used for both guiding treatment as well as predicting [[prognosis]]. The '''Durie-Salmon staging system''', first published in 1975, is a clinical staging system for [[multiple myeloma]] that correlates measured [[Multiple myeloma|myeloma]] cell mass to the presenting clinical features, response to treatment, and survival.<ref name="pmid1182674">{{cite journal| author=Durie BG, Salmon SE| title=A clinical staging system for multiple myeloma. Correlation of measured myeloma cell mass with presenting clinical features, response to treatment, and survival. | journal=Cancer | year= 1975 | volume= 36 | issue= 3 | pages= 842-54 | pmid=1182674 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1182674 }}</ref> Durie-Salmon Staging System is still in use, but has been largely superseded by the more practical ISS and revised ISS <ref name="California">About multiple myeloma. University of California San Francisco (2015)http://cancer.ucsf.edu/research/multiple-myeloma/ Accessed on September, 18 2015 </ref> | ||
==Staging== | ==Staging== | ||
=== '''International Staging System''' === | |||
According to the International Staging System (ISS), there are three stages of multiple myeloma based on both | According to the International Staging System (ISS), there are three stages of [[multiple myeloma]] based on both [[Beta-2 microglobulin|β<sub>2</sub>-microglobulin]] and [[albumin]] levels:<ref name="California">About multiple myeloma. University of California San Francisco (2015)http://cancer.ucsf.edu/research/multiple-myeloma/ Accessed on September, 18 2015 </ref> <ref name="ISS">Greipp PR, San Miguel J, Fonseca R, Avet-Loiseau H, Jacobson JL, Rasmussen E, Crowley J, Durie BMG. Development of an international prognostic index (IPI) for myeloma: report of the international myeloma working group. ''Hematology Journal'' 2003;4:S42. NLM ID 100965523.</ref> | ||
{| style="border: 0px; font-size: | {| style="border: 0px; font-size: 100%; margin: 3px; width: 1000px" | ||
|valign=top| | | valign="top" | | ||
|+ | |+ | ||
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Stage | ! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Stage}} | ||
! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Features}} | ! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Features}} | ||
! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Prognosis}} | ! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Prognosis}} | ||
Line 20: | Line 21: | ||
:Stage 1 | :Stage 1 | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
:[[beta-2-microglobulin|β<sub>2</sub>-microglobulin]] <3.5 mg/L and [[serum albumin|albumin]] ≥3.5 g/dL | |||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
:Median survival of 62 months | |||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | | | style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | | ||
:Stage 2 | :Stage 2 | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
:[[beta-2-microglobulin|β<sub>2</sub>-microglobulin]] <3.5 and albumin <3.5 | |||
or | :::::'''or''' | ||
:[[beta-2-microglobulin|β<sub>2</sub>-microglobulin]] 3.5-5.5 mg/L | |||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
:Median survival of 45 months | |||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | | | style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | | ||
:Stage 3 | :Stage 3 | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
:[[beta-2-microglobulin|β<sub>2</sub>-microglobulin]] >5.5 | |||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
:Median survival of 29 months | |||
|} | |} | ||
=== '''Revised International Staging System''' === | |||
The Revised International Staging System (R-ISS) was proposed in 2015 and incorporated [[Chromosomal aberration|chromosomal aberrations]] and [[LDH]] level to more accurately risk stratify [[patients]].<ref name="pmid26240224">{{cite journal| author=Palumbo A, Avet-Loiseau H, Oliva S, Lokhorst HM, Goldschmidt H, Rosinol L et al.| title=Revised International Staging System for Multiple Myeloma: A Report From International Myeloma Working Group. | journal=J Clin Oncol | year= 2015 | volume= 33 | issue= 26 | pages= 2863-9 | pmid=26240224 | doi=10.1200/JCO.2015.61.2267 | pmc=4846284 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26240224 }} </ref> | |||
{| style="border: 0px; font-size: 100%; margin: 3px; width: 1000px" | |||
| valign="top" | | |||
|+ | |||
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Stage}} | |||
! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Features}} | |||
! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Prognosis}} | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | | |||
:Stage 1 | |||
| style="padding: 5px 5px; background: #F5F5F5;" | | |||
*[[beta-2-microglobulin|β<sub>2</sub>-microglobulin]] <3.5 mg/L | |||
'''''and''''' | |||
*[[serum albumin|albumin]] ≥3.5 g/dL | |||
'''''and''''' | |||
*Absence of high-risk [[chromosomal abnormalities]] such as del(17p), t(4;14), or t(14;16) | |||
'''''and''''' | |||
*Normal [[LDH]] level | |||
| style="padding: 5px 5px; background: #F5F5F5;" | | |||
:5-year overall survival of 82% | |||
:5-year progression-free survival of 55% | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | | |||
:Stage 2 | |||
| style="padding: 5px 5px; background: #F5F5F5;" | | |||
Not Stage 1 or Stage 3 | |||
| style="padding: 5px 5px; background: #F5F5F5;" | | |||
:5-year overall survival of 62% | |||
:5-year progression-free survival of 36% | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | | |||
:Stage 3 | |||
| style="padding: 5px 5px; background: #F5F5F5;" | | |||
:[[beta-2-microglobulin|β<sub>2</sub>-microglobulin]] >5.5 mg/L, | |||
:'''and''' | |||
:Presence of high-risk [[chromosomal abnormalities]] such as del(17p), t(4;14), t(14;16) | |||
:'''''or''''' | |||
:Elevated [[LDH]] level | |||
| style="padding: 5px 5px; background: #F5F5F5;" | | |||
:5-year overall survival of 40% | |||
:5-year progression-free survival of 24% | |||
|} | |||
=== '''Durie-Salmon Staging System''' === | |||
According to the Durie-Salmon Staging System, there are three stages of [[multiple myeloma]] based on the [[hemoglobin]] level, [[calcium]] level, [[skeletal survey]], serum [[paraprotein]] level, and urinary [[light chain]] excretion:<ref name="California">About multiple myeloma. University of California San Francisco (2015)http://cancer.ucsf.edu/research/multiple-myeloma/ Accessed on September, 18 2015 </ref> | |||
{| style="border: 0px; font-size: 100%; margin: 3px; width: 1000px" | |||
| valign="top" | | |||
{| style=" | |||
| | |||
|+ | |+ | ||
! style="background: #4479BA; width: | ! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Stage}} | ||
! style="background: #4479BA; width: | ! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Hemoglobin level}} | ||
! style="background: #4479BA; width: | ! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Calcium level}} | ||
! style="background: #4479BA; width: 600px;" | {{fontcolor|#FFF|Skeletal survey}} | ! style="background: #4479BA; width: 600px;" | {{fontcolor|#FFF|Skeletal survey}} | ||
! style="background: #4479BA; width: | ! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Serum paraprotein level}} | ||
! style="background: #4479BA; width: | ! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Urinary light chain excretion}} | ||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | | ||
:Stage 1 | :Stage 1 | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
:>10g/dL | |||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
:8.5-10.2 mg/dL | |||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
:Normal or single [[plasmacytoma]] or [[osteoporosis]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
:<5 g/dL if IgG or <3 g/dL if IgA | |||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
:<4 g/24h | |||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | | ||
:Stage 2 | :Stage 2 | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
:8.5-10g/dL | |||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
:10.2-12 mg/dL | |||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
:Fulfilling the [[criteria]] of neither 1 nor 3 | |||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
:5-7 g/dL if IgG or 3-5 g/dL if IgA | |||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
:4-12 g/24h | |||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | | ||
:Stage 3 | :Stage 3 | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
:<8.5g/dL | |||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
:>12mg/dL | |||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
:3 or more lytic [[bone]] lesions | |||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
:>7g/dL if IgG or <br> > 5 g/dL if IgA | |||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
:>12g/24h | |||
|} | |} | ||
Stages 1, 2 and 3 of the Durie-Salmon staging system can be divided into A or B depending on serum creatinine:<ref>About multiple myeloma. University of California San Francisco (2015)http://cancer.ucsf.edu/research/multiple-myeloma/ Accessed on September, 18 2015 </ref> | Stages 1, 2 and 3 of the Durie-Salmon staging system can be divided into A or B depending on [[serum creatinine]]:<ref name="California">About multiple myeloma. University of California San Francisco (2015)http://cancer.ucsf.edu/research/multiple-myeloma/ Accessed on September, 18 2015 </ref> | ||
* A: [[serum creatinine]] < | * A: [[serum creatinine]] < 2 mg/dL (< 177 umol/L) | ||
* B: serum creatinine > | * B: [[serum creatinine]] > 2 mg/dL (> 177 umol/L) | ||
=== '''SWOG Staging System''' === | |||
The Southwest Oncology Group (SWOG) staging system is not currently widely used. Unlike the other staging systems, there are four stages in the SWOG staging system.<ref name="pmid19746184">{{cite journal| author=Choi JH, Yoon JH, Yang SK| title=Clinical value of new staging systems for multiple myeloma. | journal=Cancer Res Treat | year= 2007 | volume= 39 | issue= 4 | pages= 171-4 | pmid=19746184 | doi=10.4143/crt.2007.39.4.171 | pmc=2739370 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19746184 }} </ref> | |||
{| style="border: 0px; font-size: 100%; margin: 3px; width: 1000px" | |||
| valign="top" | | |||
|+ | |||
! colspan="2" style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|SWOG Staging System}} | |||
|- | |||
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Stage}} | |||
! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Features}} | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | | |||
:Stage 1 | |||
| style="padding: 5px 5px; background: #F5F5F5;" |[[beta-2-microglobulin|β<sub>2</sub>-microglobulin]] <2.5 mg/L | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | | |||
:Stage 2 | |||
| style="padding: 5px 5px; background: #F5F5F5;" |[[beta-2-microglobulin|β<sub>2</sub>-microglobulin]] >2.5 mg/L and <5.5 mg/L | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | | |||
:Stage 3 | |||
| style="padding: 5px 5px; background: #F5F5F5;" |[[beta-2-microglobulin|β<sub>2</sub>-microglobulin]]5.5 mg/L ''and'' albumin >3 g/dl | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | | |||
:Stage 4 | |||
| style="padding: 5px 5px; background: #F5F5F5;" |[[beta-2-microglobulin|β<sub>2</sub>-microglobulin]]>5.5 mg/L ''and'' albumin <3 g/dl | |||
|} | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category:Medicine]] | |||
[[Category: | |||
[[Category:Hematology]] | [[Category:Hematology]] | ||
[[Category: | [[Category:Neurology]] | ||
[[Category:Neurosurgery]] | |||
[[Category:Oncology]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Surgery]] |
Latest revision as of 22:47, 29 July 2020
Multiple myeloma Microchapters |
Diagnosis |
---|
Treatment |
Case Studies |
Multiple myeloma staging On the Web |
American Roentgen Ray Society Images of Multiple myeloma staging |
Risk calculators and risk factors for Multiple myeloma staging |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Hannan Javed, M.D.[2]; Haytham Allaham, M.D. [3]; Shyam Patel [4]
Overview
Multiple myeloma may be divided into three stages based on either the International Staging System (ISS) or Durie-Salmon Staging System.[1] The International Staging System for multiple myeloma was published by the International Myeloma Working Group in 2003 and is the most widely used staging system.[1][2] It is used for both guiding treatment as well as predicting prognosis. The Durie-Salmon staging system, first published in 1975, is a clinical staging system for multiple myeloma that correlates measured myeloma cell mass to the presenting clinical features, response to treatment, and survival.[3] Durie-Salmon Staging System is still in use, but has been largely superseded by the more practical ISS and revised ISS [1]
Staging
International Staging System
According to the International Staging System (ISS), there are three stages of multiple myeloma based on both β2-microglobulin and albumin levels:[1] [2]
Stage | Features | Prognosis |
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Revised International Staging System
The Revised International Staging System (R-ISS) was proposed in 2015 and incorporated chromosomal aberrations and LDH level to more accurately risk stratify patients.[4]
Stage | Features | Prognosis |
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and
and
and
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Not Stage 1 or Stage 3 |
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Durie-Salmon Staging System
According to the Durie-Salmon Staging System, there are three stages of multiple myeloma based on the hemoglobin level, calcium level, skeletal survey, serum paraprotein level, and urinary light chain excretion:[1]
Stage | Hemoglobin level | Calcium level | Skeletal survey | Serum paraprotein level | Urinary light chain excretion |
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Stages 1, 2 and 3 of the Durie-Salmon staging system can be divided into A or B depending on serum creatinine:[1]
- A: serum creatinine < 2 mg/dL (< 177 umol/L)
- B: serum creatinine > 2 mg/dL (> 177 umol/L)
SWOG Staging System
The Southwest Oncology Group (SWOG) staging system is not currently widely used. Unlike the other staging systems, there are four stages in the SWOG staging system.[5]
SWOG Staging System | |
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Stage | Features |
|
β2-microglobulin <2.5 mg/L |
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β2-microglobulin >2.5 mg/L and <5.5 mg/L |
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β2-microglobulin5.5 mg/L and albumin >3 g/dl |
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β2-microglobulin>5.5 mg/L and albumin <3 g/dl |
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 About multiple myeloma. University of California San Francisco (2015)http://cancer.ucsf.edu/research/multiple-myeloma/ Accessed on September, 18 2015
- ↑ 2.0 2.1 Greipp PR, San Miguel J, Fonseca R, Avet-Loiseau H, Jacobson JL, Rasmussen E, Crowley J, Durie BMG. Development of an international prognostic index (IPI) for myeloma: report of the international myeloma working group. Hematology Journal 2003;4:S42. NLM ID 100965523.
- ↑ Durie BG, Salmon SE (1975). "A clinical staging system for multiple myeloma. Correlation of measured myeloma cell mass with presenting clinical features, response to treatment, and survival". Cancer. 36 (3): 842–54. PMID 1182674.
- ↑ Palumbo A, Avet-Loiseau H, Oliva S, Lokhorst HM, Goldschmidt H, Rosinol L; et al. (2015). "Revised International Staging System for Multiple Myeloma: A Report From International Myeloma Working Group". J Clin Oncol. 33 (26): 2863–9. doi:10.1200/JCO.2015.61.2267. PMC 4846284. PMID 26240224.
- ↑ Choi JH, Yoon JH, Yang SK (2007). "Clinical value of new staging systems for multiple myeloma". Cancer Res Treat. 39 (4): 171–4. doi:10.4143/crt.2007.39.4.171. PMC 2739370. PMID 19746184.