TABLE 3: T YPES OF MYELOMA
TABLE 4: THE DURIE AND SALMON STAGING SYSTEM
HEAVY CHAIN*
LIGHT CHAIN**
MYELOMA TYPE
STAGE
CRITERIA
MEASURED MYELOMA
CELL MASS
IgG:
kappa ()
IgG or IgG immunoglobulin G
(myeloma cells in billions/m2)*
(immunoglobulin G)
or
with kappa or lambda light chains
lambda ( or L)
STAGE I
All of the following:
600 billion*
(low cell mass)
· Hemoglobin value >10g/dL
IgA:
kappa ()
IgA or IgA immunoglobulin A
· Serum calcium value normal
(immunoglobulin A)
or
with kappa or lambda light chains
or <10.5mg/dL
lambda ( or L)
· Bone x-ray, normal bone structure (scale
0), or solitary bone plasmacytoma only
*Rarer types are IgD, IgE and IgM
· Low M-component production rates
**There are only 2 light chain types
IgG value <5g/dL; IgA value <3g/dL
There are subtle differences in the behaviors of different types of myeloma. IgG myelo-
· Urine light chain M-component on
ma has the usual features of myeloma. The IgA type can sometimes be characterized by
electrophoresis <4g/24h
tumors outside of the bone. The IgD type can be accompanied by plasma-cel leukemia
STAGE II
Fitting neither Stage I nor Stage III
600 to 1,200 billion*
and more frequently causes kidney damage. The light chain or Bence Jones myelomas
(intermediate
*myeloma cells in whole body
are the most likely to cause kidney damage and/or lead to deposits of light chains in the
cell mass)
kidneys and/or on nerves or other organs. Depending upon the characteristics of the
STAGE III
One or more of the following:
>1,200 billion*
light chain deposits, this condition is called either amyloid or light chain deposition.
(high cell mass) · Hemoglobin value <8.5g/dL
· Serum calcium value >12mg/dL
· Advanced lytic bone lesions (scale 3)
staGInG of MYeloMa
· High M-component production rates
IgG value >7g/dL IgA value >5g/dL
· Bence Jones protein >12g/24h
When myeloma is diagnosed, the amount of myeloma in the body varies from patient
to patient. This is cal ed the stage of myeloma. The previously most commonly used
SUBCLASS-
· A: relatively normal renal function
IFICATION
(serum creatinine value) <2.0 mg/dL
staging system is shown in Table 4, and shows the correlation between the extent of
(either A or B)
· B: abnormal renal function
the myeloma and the damage caused, such as bone disease or anemia. The outlook is
(serum creatinine value) >2.0 mg/dL
better when treatment is started early and bone disease or other complications can be
Examples: Stage IA (low cell mass with
prevented. The most current staging system is shown in Table 5, and is the result of the
normal renal function) Stage IIIB (high cell
collaboration of more than twenty research institutions world-wide.
mass with abnormal renal function)
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