Pasqualetti et al developed a myeloma staging system based on clinical and histological findings. The stages differed in total survival time, median survival and response to chemotherapy. The authors are from L'Aquila in Italy.
Parameters identified on multivariate analysis:
(1) bone marrow plasma cells: percent, absolute number, absolute number of plasmablasts
(2) hemoglobin
(3) lytic bone lesions on X-rays
(4) serum beta-2-microglobulin
(5) Bence-Jones proteinuria
|
Parameter |
Finding |
Points |
|
bone marrow plasma cells |
<= 30% |
0 |
|
|
> 30% |
1 |
|
hemoglobin |
>= 110 g/L |
0 |
|
|
< 110 g/L |
1 |
|
lytic bone lesions |
none or grade 1 |
0 |
|
|
grade 2 or 3 |
1 |
|
serum beta-2-microglobulin |
<= 678 nmol/L |
0 |
|
|
> 678 nmol/L |
1 |
|
Bence-Jones proteinuria |
absent |
0 |
|
|
present |
1 |
where:
• grade 2 lytic bone lesions = multiple lytic lesions
• grade 3 lytic bone lesions = advanced multiple lytic lesions and/or pathological fractures
• molecular weight of beta-2-microglobulun: 11,800 grams
• 1 µg/mL beta-2-microglobulin = 84.746 nmol/L; 678 nmol/L corresponds to 8 µg/mL
staging score =
= SUM(points for 5 parameters)
multiple myeloma cellular score =
= (0.752 * (total bone marrow myeloma cell count in 500 nucleated marrow cells) / 500) + (0.709 * (total bone marrow plasmablasts in 500 nucleated marrow cells) / 500)
where:
• plasmablasts = immature, with centrally located, large nucleus containing several nucleoli, with only a relatively small rim of cytoplasm
• total bone marrow myeloma cells = (total non-plasmablasts) + (total plasmablasts)
• total bone marrow myeloma cells in 500 cells = (percent plasma cells, from 0 to 100) * 5
Interpretation:
• minimum staging score: 0
• maximum staging score: 5
|
Staging Score |
Stage |
|
0 or 1 |
I |
|
2 or 3 |
II |
|
4 or 5 |
III |
|
Cellular Score |
Substage |
|
< 0.300 |
A |
|
> 0.300 |
B |
where:
• no provision appears to be given for cellular score = 0.300
|
Stage |
Maximal Survival in Years |
Median Survival in Months |
Standard Deviation in Months |
|
IA |
10.0 |
86 |
31 |
|
IB |
8.5 |
60 |
23 |
|
IIA |
6.6 |
44 |
19 |
|
IIB |
4.5 |
29 |
13 |
|
IIIA |
3.5 |
21 |
11 |
|
IIIB |
2.3 |
13 |
20 |
from page 1125
|
Stage |
Complete Remission |
Partial Remission to Therapy |
No Response to Therapy |
|
IA |
66.7% |
17.8% |
5.5% |
|
IB |
60% |
28% |
12% |
|
IIA |
30.8% |
46.1% |
23.1% |
|
IIB |
21.2% |
36.4% |
42.4% |
|
IIIA |
20% |
44% |
36% |
|
IIIB |
6.2% |
34.4% |
59.4% |
from page 1125, based on therapy regimens given prior to 1991
Specialty: Hematology Oncology
ICD-10: ,
