STAGING & PROGNOSTIC CLASSIFICATION

Before development of a treatment plan, it is extremely helpful to determine the stage and prognostic classification for each patient. The Durie and Salmon Staging System, in use since 1975, is very helpful both in assessing the outlook for individual patients as well as in classifying the patient for clinical trials and to compare with previously published results.

Subclassification A:
Relatively normal renal function (serum creatinine value <2.0mg/dL)

Subclassification B:
Abnormal renal function (serum creatinine value >2.0mg/dL)

Additional prognostic factors are used to simply and reproducibly categorize patients as a basis for treatment planning.

More complex prognostic factor tests:
A number of additional tests have been shown to be prognostically helpful. However, these tests are not always available and/or are very expensive to perform on a routine basis.

THE DURIE AND SALMON STAGING SYSTEM
STAGE
CRITERIA
MEASURED
MYELOMA
CELL MASS
(CELLS X 1012/M2)
Stage I
(A or B)

low cell mass

 All of the following :
  • Hemoglobin value >10g/dL
  • Serum calcium value normal or <12mg/L
  • On bone x-ray, normal bone structure (scale 0), or solitary bone plasmacytoma only.
  • Low M-component production rate IgG value <5g/L; IgA value <3g/dL
  • Bence Jones protein <4g/24h
<0.6
Stage II
(A or B)

intermediate cell mass

 Fitting neither Stage I nor Stage III criteria. 0.6 - 1.2
Stage III
(A or B)

high cell mass

 One or more of the following :
  • Hemoglobin value <8.5g/L
  • Serum calcium value >12mg/dL
  • Advanced lytic bone lesions (scale 3)
  • High M-component production rate IgG value >7g/dL; IgA value >5g/dL
  • Bence Jones protein >12g/24h
>1.2

Plasma cell labeling index (PCLI):
Expressed as a percentage. A low labeling index is favorable. Fresh bone marrow and/or blood samples need to be sent to the Mayo Clinic for testing.

Chromosome analysis:
Standard cytogenetic studies and/or FISH analysis (fluorescent in situ hybridization) can be performed on fresh bone marrow material. Abnormal chromosomes, especially loss of all or part of chromosome 13, indicate a poorer outlook, with myeloma less likely to respond to treatment.

Molecular array analysis:
This is currently a research technique to assess which genes are active and may correlate with good or poor prognosis.

TEST
SIGNIFICANCE
Serum Beta 2 Microglobulin

(Sß2M)

 A simple, widely-available blood test, which should be performed on all patients. High levels indicate more active myeloma.
Serum Albumin

(S. Alb.)

 Normal blood protein routinely measures as part of chemistry panel. Low levels indicate less favorable disease.
C-Reactive protein

(CRP)

 A normal blood protein. Increased levels indicate more active myeloma.

    This information was taken from the 2003 IMF Patient Handbook, part of the free IMF Info Pack. To order your copy, click here. If you have questions about the information on this page, or about any aspect of myeloma, call the IMF Hotline at (800) 452-CURE.