Multiple myeloma staging
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Risk calculators and risk factors for Multiple myeloma staging |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
International Staging System for myeloma, based on β2-microglobulin (β2M) levels and serum albumin levels, was published by International myeloma working group in 2003 and is the most widely used staging system. It is used for both guiding treatment as well as predicting prognosis.
Staging
- International Staging System
The International Staging System (ISS) for myeloma was published by the International Myeloma Working Group in 2003 [1]:
- Stage I: β2-microglobulin (β2M) < 3.5 mg/L, albumin >= 3.5 g/dL
- Stage II: β2M < 3.5 and albumin < 3.5; or β2M between 3.5 and 5.5
- Stage III: β2M > 5.5
- Durie-Salmon staging system
First published in 1975, the Durie-Salmon staging system [2] is still in use, but has largely been superseded by the simpler ISS:
- stage 1: all of
- Hb > 10g/dL
- normal calcium
- Skeletal survey: normal or single plasmacytoma or osteoporosis
- Serum paraprotein level < 5 g/dL if IgG, < 3 g/dL if IgA
- Urinary light chain excretion < 4 g/24h
- stage 2: fulfilling the criteria of neither 1 nor 3
- stage 3: one or more of
- Hb < 8.5g/dL
- high calcium > 12mg/dL
- Skeletal survey: 3 or more lytic bone lesions
- Serum paraprotein >7g/dL if IgG, > 5 g/dL if IgA
- Urinary light chain excretion > 12g/24h
Stages 1, 2 and 3 of the Durie-Salmon staging system can be divided into A or B depending on serum creatinine:
- A: serum creatinine < 2mg/dL (< 177 umol/L)
- B: serum creatinine > 2mg/dL (> 177 umol/L)
References
- ↑ 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. A clinical staging system for multiple myeloma. Correlation of measured myeloma cell mass with presenting clinical features, response to treatment and survival. Cancer 1975;36:842–854. PMID 1182674.