The Durie-Salmon staging system for multiple myeloma has been used for decades and is based on concentrations of monoclonal immunoglobulins, calcium, hemoglobin and the extent of bone involvement.
The International Staging System is presently recommended which focuses on Beta2 microglobulin and serum albumin.
Stage III in both systems is the most advanced.
The Durie-Salmon criteria: uses standard laboratory measurements of calcium, renal function, hemoglobin, and the number of lytic lesions.
Stage I-all of the following-hemoglobin of greater than 10 g per deciliter, serum calcium normal or less than 12 mg per deciliter, normal bone x-rays or solitary bone plasmacytoma only, IgG <5 g per deciliter, IgA of less than 3 g per deciliter, and Bence Jones protein of less than 4 g per 24 hours.
Stage II-neither stage I or III.
Stage III-one or more of the following-hemoglobin <8.5 g per deciliter, serum calcium greater than 12 mg per deciliter, advanced lytic bone lesions, IgG >7 grams per deciliter, IgA of greater than 5 g per deciliter, and Bence-Jones protein grave and 12 g per 24 hours.
Patients of further subclassified as either A or B: a- relatively normal renal function with a serum creatinine of less than 2 mg/dL and B-normal renal function with serum creatinine of 2.0 mg/dL or greater.
The system is predictive of clinical outcome after standard dose chemotherapy.
Limitations of the DS system is interobserver variability on the number of lytic lesions found on a skeletal survey.
The DS staging system predates MRI and PET can which are more sensitive in detecting osseous disease.
The DS staging system does not reflect the serum free light chain assay which can identify many oligosecretory and nonsecretory patients with myeloma.
International Staging System (ISS):
Stage I-serum beta two microglobulin less than 3.5 mg per deciliter and serum albumin equal or greater than 3.5 g per deciliter.
Stage II-neither stage I or III
Stage III-serum beta two microglobulin equal to or greater than 5.5 mg per deciliter
The International staging system no includes side of genetic characteristics, and LDH levels, and the new system is known as the R-ISS.
R2-ISS includes the prognostic factor 1Q gain or amplification.
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