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Myeloma Staging System

Purpose: To stage multiple myeloma based on clinical and laboratory findings.

Description

Multiple myeloma involves a malignant proliferation of plasma cells. As the disease progresses, tumor replaces the marrow causing anemia, forms osteolytic bone lesions causing hypercalcemia and fractures, and produces increasing amounts of the associated monoclonal protein(s). The method of Durie and Salmon is estimates tumor burden based on myeloma protein synthesis rates and a calculation of the total body tumor cell mass.


Stage

Criteria

I

all of the following

• hemoglobin > 10 g/dL

• serum calcium <= 12 mg/dL

• X-ray: 0-1 bony lesions

• monoclonal protein: IgG < 5 g/dL; IgA < 3 g/dL; urine light chain excretion < 4 g/24 hrs

II

fits neither stage I or III

 

III

any of the following

• hemoglobin < 8.5 g/dL

• serum calcium > 12 mg/dL

• extensive lytic bone lesions; widespread with fractures

• monoclonal protein: IgG > 7 g/dL; IgA > 5 g/dL; urine light chain excretion > 12 g/24 hrs

 

where:

• The definition of "extensive bone lesions" for Stage III has received different definitions; the use of "4 or more lesions" by itself should not be used to classify a patient as Stage III (Greipp page 27).

 

Subclassification within each stage:

• A: serum creatinine < 2 mg/dL

• B: serum creatinine >= 2 mg/dL

 

Stage

Myeloma Cell Mass

Median Survival, in Months

I

low (< 0.6 * 10^12 cells per meter squared)

64

II

intermediate (0.6-1.2 * 10^12 cells per meter squared)

32

III

high (> 1.2 * 10^12 cells per meter squared)

6

 

 


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Specialty

Objective

ICD-10