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Table 66-4

Myeloma Staging Systems

Durie-Salmon Staging System
StageCriteriaEstimated tumor burden × 1012 cells/m2
IAll of the following:<0.6 (low)
1. Hemoglobin >100 g/L (>10 g/dL)
2. Serum calcium<3 mmol/L (<12 mg/dL)
3. Normal bone x-ray or solitary lesion
4. Low M-component production
a. IgG level <50 g/L (<5 g/dL)
b. IgA level <30 g/L (<3 g/dL)
c. Urine light chain <4 g/24 h
IIFitting neither I nor III0.6-1.20 (intermediate)
IIIOne or more of the following:>1.20 (high)
1. Hemoglobin <85 g/L (<8.5 g/dL)
2. Serum calcium >3 mmol/L (>12 mg/dL)
3. Advanced lytic bone lesions
4. High M-component production
a. IgG level >70 g/L (>7 g/dL)
b. IgA level >50 g/L (>5 g/dL)
c. Urine light chains >12 g/24 h
LevelStageMedian Survival, Months
Subclassification based on serum creatinine levels
A <177 µmol/L (<2 mg/dL)IA61
B >177 µmol/L (>2 mg/dL)IIA, B55
IIIA30
IIIB15
International Staging System
β2M <3.5, alb 3.5I (28%)62
β2M <3.5, alb <3.5 orβ2M = 3.5-5.5II (39%)44
β2M >5.5III (33%)29

Note:β2M, serum β2-microglobulin in mg/L; alb, serum albumin in g/dL; (#), % pts presenting at each stage.