Multiple myeloma staging: Difference between revisions
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==Overview== | ==Overview== | ||
Multiple myeloma may be divided into three stages based on either the International Staging System (ISS) or Durie-Salmon Staging System.<ref name="California">About multiple myeloma. University of California San Francisco (2015)http://cancer.ucsf.edu/research/multiple-myeloma/ Accessed on September, 18 2015 </ref> The International Staging System for multiple myeloma was published by the International Myeloma Working Group in 2003 and is the most widely used staging system.<ref name="California">About multiple myeloma. University of California San Francisco (2015)http://cancer.ucsf.edu/research/multiple-myeloma/ Accessed on September, 18 2015 </ref><ref name="ISS">Greipp PR, San Miguel J, Fonseca R, Avet-Loiseau H, Jacobson JL, Rasmussen E, Crowley J, Durie BMG. Development of an international prognostic index (IPI) for myeloma: report of the international myeloma working group. ''Hematology Journal'' 2003;4:S42. NLM ID 100965523.</ref> It is used for both guiding treatment as well as predicting prognosis. The Durie-Salmon staging system, first published in 1975, is a clinical staging system for multiple myeloma that correlates measured myeloma cell mass to the presenting clinical features, response to treatment, and survival.<ref name="pmid1182674">{{cite journal| author=Durie BG, Salmon SE| title=A clinical staging system for multiple myeloma. Correlation of measured myeloma cell mass with presenting clinical features, response to treatment, and survival. | journal=Cancer | year= 1975 | volume= 36 | issue= 3 | pages= 842-54 | pmid=1182674 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1182674 }}</ref> Durie-Salmon Staging System is still in use, but has been largely superseded by the more practical ISS and revised ISS <ref name="California">About multiple myeloma. University of California San Francisco (2015)http://cancer.ucsf.edu/research/multiple-myeloma/ Accessed on September, 18 2015 </ref> | [[Multiple myeloma]] may be divided into three stages based on either the International Staging System (ISS) or Durie-Salmon Staging System.<ref name="California">About multiple myeloma. University of California San Francisco (2015)http://cancer.ucsf.edu/research/multiple-myeloma/ Accessed on September, 18 2015 </ref> The International Staging System for [[multiple myeloma]] was published by the International Myeloma Working Group in 2003 and is the most widely used staging system.<ref name="California">About multiple myeloma. University of California San Francisco (2015)http://cancer.ucsf.edu/research/multiple-myeloma/ Accessed on September, 18 2015 </ref><ref name="ISS">Greipp PR, San Miguel J, Fonseca R, Avet-Loiseau H, Jacobson JL, Rasmussen E, Crowley J, Durie BMG. Development of an international prognostic index (IPI) for myeloma: report of the international myeloma working group. ''Hematology Journal'' 2003;4:S42. NLM ID 100965523.</ref> It is used for both guiding treatment as well as predicting [[prognosis]]. The Durie-Salmon staging system, first published in 1975, is a clinical staging system for [[multiple myeloma]] that correlates measured [[Multiple myeloma|myeloma]] cell mass to the presenting clinical features, response to treatment, and survival.<ref name="pmid1182674">{{cite journal| author=Durie BG, Salmon SE| title=A clinical staging system for multiple myeloma. Correlation of measured myeloma cell mass with presenting clinical features, response to treatment, and survival. | journal=Cancer | year= 1975 | volume= 36 | issue= 3 | pages= 842-54 | pmid=1182674 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1182674 }}</ref> Durie-Salmon Staging System is still in use, but has been largely superseded by the more practical ISS and revised ISS <ref name="California">About multiple myeloma. University of California San Francisco (2015)http://cancer.ucsf.edu/research/multiple-myeloma/ Accessed on September, 18 2015 </ref> | ||
==Staging== | ==Staging== | ||
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{| style="border: 0px; font-size: 100%; margin: 3px; width: 1000px" | {| style="border: 0px; font-size: 100%; margin: 3px; width: 1000px" | ||
|valign=top| | | valign="top" | | ||
|+ | |+ | ||
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Stage}} | ! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Stage}} | ||
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:Stage 2 | :Stage 2 | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
:β<sub>2</sub>-microglobulin <3.5 and albumin <3.5 | :[[beta-2-microglobulin|β<sub>2</sub>-microglobulin]] <3.5 and albumin <3.5 | ||
:::::'''or''' | :::::'''or''' | ||
:β<sub>2</sub>-microglobulin 3.5-5.5 mg/L | :[[beta-2-microglobulin|β<sub>2</sub>-microglobulin]] 3.5-5.5 mg/L | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
:Median survival of 45 months | :Median survival of 45 months | ||
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:Stage 3 | :Stage 3 | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
:β<sub>2</sub>-microglobulin >5.5 | :[[beta-2-microglobulin|β<sub>2</sub>-microglobulin]] >5.5 | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
:Median survival of 29 months | :Median survival of 29 months | ||
|} | |} | ||
;'''Revised International Staging System''' | ;'''Revised International Staging System''' | ||
The Revised International Staging System (R-ISS) was proposed in 2015 and incorporated chromosomal aberrations and LDH level to more accurately risk stratify patients.<ref name="pmid26240224">{{cite journal| author=Palumbo A, Avet-Loiseau H, Oliva S, Lokhorst HM, Goldschmidt H, Rosinol L et al.| title=Revised International Staging System for Multiple Myeloma: A Report From International Myeloma Working Group. | journal=J Clin Oncol | year= 2015 | volume= 33 | issue= 26 | pages= 2863-9 | pmid=26240224 | doi=10.1200/JCO.2015.61.2267 | pmc=4846284 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26240224 }} </ref> | The Revised International Staging System (R-ISS) was proposed in 2015 and incorporated [[Chromosomal aberration|chromosomal aberrations]] and [[LDH]] level to more accurately risk stratify [[patients]].<ref name="pmid26240224">{{cite journal| author=Palumbo A, Avet-Loiseau H, Oliva S, Lokhorst HM, Goldschmidt H, Rosinol L et al.| title=Revised International Staging System for Multiple Myeloma: A Report From International Myeloma Working Group. | journal=J Clin Oncol | year= 2015 | volume= 33 | issue= 26 | pages= 2863-9 | pmid=26240224 | doi=10.1200/JCO.2015.61.2267 | pmc=4846284 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26240224 }} </ref> | ||
{| style="border: 0px; font-size: 100%; margin: 3px; width: 1000px" | {| style="border: 0px; font-size: 100%; margin: 3px; width: 1000px" | ||
|valign=top| | | valign="top" | | ||
|+ | |+ | ||
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Stage}} | ! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Stage}} | ||
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| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
*[[beta-2-microglobulin|β<sub>2</sub>-microglobulin]] <3.5 mg/L | *[[beta-2-microglobulin|β<sub>2</sub>-microglobulin]] <3.5 mg/L | ||
''and'' | '''''and''''' | ||
*[[serum albumin|albumin]] ≥3.5 g/dL | *[[serum albumin|albumin]] ≥3.5 g/dL | ||
''and'' | '''''and''''' | ||
*Absence of high-risk chromosomal abnormalities such as del(17p), t(4;14), or t(14;16) | *Absence of high-risk [[chromosomal abnormalities]] such as del(17p), t(4;14), or t(14;16) | ||
''and'' | '''''and''''' | ||
*Normal LDH level | *Normal [[LDH]] level | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
:5-year overall survival of 82% | :5-year overall survival of 82% | ||
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:Stage 3 | :Stage 3 | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
:β<sub>2</sub>-microglobulin >5.5 mg/L, ''and' | :[[beta-2-microglobulin|β<sub>2</sub>-microglobulin]] >5.5 mg/L, | ||
:'''and''' | |||
:Presence of high-risk [[chromosomal abnormalities]] such as del(17p), t(4;14), t(14;16) | |||
:'''''or''''' | |||
:Elevated [[LDH]] level | |||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
:5-year overall survival of 40% | :5-year overall survival of 40% | ||
:5-year progression-free survival of 24% | :5-year progression-free survival of 24% | ||
|} | |} | ||
;'''Durie-Salmon Staging System''' | ;'''Durie-Salmon Staging System''' | ||
According to the Durie-Salmon Staging System, there are three stages of multiple myeloma based on the [[hemoglobin]] level, [[calcium]] level, [[skeletal survey]], serum | According to the Durie-Salmon Staging System, there are three stages of [[multiple myeloma]] based on the [[hemoglobin]] level, [[calcium]] level, [[skeletal survey]], serum [[paraprotein]] level, and urinary [[light chain]] excretion:<ref name="California">About multiple myeloma. University of California San Francisco (2015)http://cancer.ucsf.edu/research/multiple-myeloma/ Accessed on September, 18 2015 </ref> | ||
{| style="cellpadding=0; cellspacing= 0; width: 1000px;" | {| style="cellpadding=0; cellspacing= 0; width: 1000px;" | ||
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:8.5-10.2 mg/dL | :8.5-10.2 mg/dL | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
:Normal or single plasmacytoma or [[osteoporosis]] | :Normal or single [[plasmacytoma]] or [[osteoporosis]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
:<5 g/dL if IgG or <3 g/dL if IgA | :<5 g/dL if IgG or <3 g/dL if IgA | ||
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:>12mg/dL | :>12mg/dL | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
:3 or more lytic bone lesions | :3 or more lytic [[bone]] lesions | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
:>7g/dL if IgG or <br> > 5 g/dL if IgA | :>7g/dL if IgG or <br> > 5 g/dL if IgA | ||
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|} | |} | ||
Stages 1, 2 and 3 of the Durie-Salmon staging system can be divided into A or B depending on serum creatinine:<ref name="California">About multiple myeloma. University of California San Francisco (2015)http://cancer.ucsf.edu/research/multiple-myeloma/ Accessed on September, 18 2015 </ref> | Stages 1, 2 and 3 of the Durie-Salmon staging system can be divided into A or B depending on [[serum creatinine]]:<ref name="California">About multiple myeloma. University of California San Francisco (2015)http://cancer.ucsf.edu/research/multiple-myeloma/ Accessed on September, 18 2015 </ref> | ||
* A: [[serum creatinine]] < 2mg/dL (< 177 umol/L) | * A: [[serum creatinine]] < 2mg/dL (< 177 umol/L) | ||
* B: serum creatinine > 2mg/dL (> 177 umol/L) | * B: [[serum creatinine]] > 2mg/dL (> 177 umol/L) | ||
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The Southwest Oncology Group (SWOG) staging system is not currently widely used. Unlike the other staging systems, there are four stages in the SWOG staging system. | The Southwest Oncology Group (SWOG) staging system is not currently widely used. Unlike the other staging systems, there are four stages in the SWOG staging system. | ||
{| style="border: 0px; font-size: 100%; margin: 3px; width: 1000px" | {| style="border: 0px; font-size: 100%; margin: 3px; width: 1000px" | ||
|valign=top| | | valign="top" | | ||
|+ | |+ | ||
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Stage}} | ! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Stage}} | ||
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | | ||
:Stage 1 | :Stage 1 | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" |[[beta-2-microglobulin|β<sub>2</sub>-microglobulin]] <2.5 mg/L | ||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | | | style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | | ||
:Stage 2 | :Stage 2 | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" |[[beta-2-microglobulin|β<sub>2</sub>-microglobulin]] >2.5 mg/L and <5.5 mg/L | ||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | | | style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | | ||
:Stage 3 | :Stage 3 | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
:β<sub>2</sub>-microglobulin | :[[beta-2-microglobulin|β<sub>2</sub>-microglobulin]]5.5 mg/L ''and'' albumin >3 g/dl | ||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | | | style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | | ||
:Stage 4 | :Stage 4 | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
:β<sub>2</sub>-microglobulin >5.5 mg/L ''and'' albumin <3 g/dl | :[[beta-2-microglobulin|β<sub>2</sub>-microglobulin]]>5.5 mg/L ''and'' albumin <3 g/dl | ||
|} | |} | ||
Revision as of 15:33, 7 November 2018
Multiple myeloma Microchapters |
Diagnosis |
---|
Treatment |
Case Studies |
Multiple myeloma staging On the Web |
American Roentgen Ray Society Images of Multiple myeloma staging |
Risk calculators and risk factors for Multiple myeloma staging |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Haytham Allaham, M.D. [2] Shyam Patel [3]
Overview
Multiple myeloma may be divided into three stages based on either the International Staging System (ISS) or Durie-Salmon Staging System.[1] The International Staging System for multiple myeloma was published by the International Myeloma Working Group in 2003 and is the most widely used staging system.[1][2] It is used for both guiding treatment as well as predicting prognosis. The Durie-Salmon staging system, first published in 1975, is a clinical staging system for multiple myeloma that correlates measured myeloma cell mass to the presenting clinical features, response to treatment, and survival.[3] Durie-Salmon Staging System is still in use, but has been largely superseded by the more practical ISS and revised ISS [1]
Staging
- International Staging System
According to the International Staging System (ISS), there are three stages of multiple myeloma based on both β2-microglobulin and albumin levels:[1] [2]
Stage | Features | Prognosis |
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- Revised International Staging System
The Revised International Staging System (R-ISS) was proposed in 2015 and incorporated chromosomal aberrations and LDH level to more accurately risk stratify patients.[4]
Stage | Features | Prognosis |
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and
and
and
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Not Stage 1 or Stage 3 |
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- Durie-Salmon Staging System
According to the Durie-Salmon Staging System, there are three stages of multiple myeloma based on the hemoglobin level, calcium level, skeletal survey, serum paraprotein level, and urinary light chain excretion:[1]
Stage | Hemoglobin level | Calcium level | Skeletal survey | Serum paraprotein level | Urinary light chain excretion |
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Stages 1, 2 and 3 of the Durie-Salmon staging system can be divided into A or B depending on serum creatinine:[1]
- A: serum creatinine < 2mg/dL (< 177 umol/L)
- B: serum creatinine > 2mg/dL (> 177 umol/L)
- SWOG Staging System[5]
The Southwest Oncology Group (SWOG) staging system is not currently widely used. Unlike the other staging systems, there are four stages in the SWOG staging system.
Stage | Features |
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β2-microglobulin <2.5 mg/L |
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β2-microglobulin >2.5 mg/L and <5.5 mg/L |
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References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 About multiple myeloma. University of California San Francisco (2015)http://cancer.ucsf.edu/research/multiple-myeloma/ Accessed on September, 18 2015
- ↑ 2.0 2.1 Greipp PR, San Miguel J, Fonseca R, Avet-Loiseau H, Jacobson JL, Rasmussen E, Crowley J, Durie BMG. Development of an international prognostic index (IPI) for myeloma: report of the international myeloma working group. Hematology Journal 2003;4:S42. NLM ID 100965523.
- ↑ Durie BG, Salmon SE (1975). "A clinical staging system for multiple myeloma. Correlation of measured myeloma cell mass with presenting clinical features, response to treatment, and survival". Cancer. 36 (3): 842–54. PMID 1182674.
- ↑ Palumbo A, Avet-Loiseau H, Oliva S, Lokhorst HM, Goldschmidt H, Rosinol L; et al. (2015). "Revised International Staging System for Multiple Myeloma: A Report From International Myeloma Working Group". J Clin Oncol. 33 (26): 2863–9. doi:10.1200/JCO.2015.61.2267. PMC 4846284. PMID 26240224.
- ↑ Choi JH, Yoon JH, Yang SK (2007). "Clinical value of new staging systems for multiple myeloma". Cancer Res Treat. 39 (4): 171–4. doi:10.4143/crt.2007.39.4.171. PMC 2739370. PMID 19746184.