Monday, August 15, 2011

Staging in Multiple Myeloma

Two main staging systems exist for multiple myeloma: the Durie-Salmon staging system and the International Staging System. The systems have low concordance with each other (36%), but both seem to be predictive of progression-free and overall survival.

Durie-Salmon Staging System

The older Durie-Salmon staging system uses a combination of 4 factors: immunoglobulin levels, hemoglobin, calcium levels, and the number of bone lesions on radiographs.
  • Stage I: All of the following:
    • Hgb > 10 g/dL, AND
    • Calcium ≤ 12 mg/dL, AND
    • Low M-component production rates: IgG < 5 g/dL, IgA < 3 g/dL, Urine light chain M-component on electrophoresis < 4 g/24 hours, AND
    • Radiographs normal or with a single bone plasmacytoma.
  • Stage II: neither Stage I or Stage III
  • Stage III: One or more of the following
    • Hgb < 8.5 g/dL, OR
    • Calcium > 12 mg/dL, OR
    • High M-component production rates: IgG > 7 g/dL, IgA > 5 g/dL, Urine light chain M-component on electrophoresis > 12 g/24 hours
    • Advanced lytic bone lesions
Each stage is further divided into A and B based on renal function:
  • A: Relatively normal renal function, with serum creatinine < 2.0 mg/dL
  • B: Abnormal renal function, with serum creatinine ≥ 2.0 mg/dL

International Staging System

This newer staging system uses serum albumin and β2-microglobulin levels to divide patients into 3 stages.
  • Stage I: β2-microglobulin < 3.5 mg/L; albumin ≥ 3.5 g/dL
  • Stage II: Neither stage I or III.
    Has two categories: β2-microglobulin < 3.5 mg/L but albumin < 3.5 g/dL, or β2-microglobulin 3.5 mg/L - 5.5 mg/L irrespective of the albumin level.
  • Stage III: β2-microglobulin ≥ 5.5 mg/L


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