staging myeloma

There are several systems that are used to “stage” active myeloma. The two main systems are the International Staging System (ISS) and the Durie Salmon Staging System.

The ISS system is based upon two blood test results:

Beta 2 microglobulin (ß2M) – ß2M is a protein that is normally found on the surface of cells. A higher-than-normal level of this protein indicates inflammation somewhere in the body. It may also indicate some types of white blood cell (lymphocyte) disorders. A normal level of ß2M in the blood is usually less than 2.5 μg/mL, depending on the laboratory.

Albumin – The most common form of protein in the blood plasma is albumin. The normal range for albumin is between 35 to 50 g/L (in American units, 3.5 to 5.0 g/dL). Lower levels may be an indicator of kidney dysfunction.

The Durie Salmon Staging System requires a number of other blood tests. They include:

Hemoglobin (Hb) is a measure of the total amount of hemoglobin in the blood. Hemoglobin is the protein in the red blood cell that carries and releases oxygen. Normal hemoglobin levels are 120 to 160 g/L for adult women and 130 to 180 for men (equivalent American values are 12 to 16 g/dL for women and 13 to 18 g/dL for males). Abnormally low values may indicate anemia.

Serum Calcium – Although calcium is an important electrolyte in the body, too much calcium in the blood can be an indicator of bone disease. Normal value ranges may vary slightly among different laboratories but are usually between 2.10 to 2.55 mmol/L (in American units, from 8.5 to 10.2 mg/dL).

Serum monoclonal proteins – This refers to the level of individual M-proteins, such as IgG, IgA, etc., or free light chains.

Serum creatinine -- Creatinine is a byproduct produced when creatine phosphate is broken down, an important part of muscle. If kidney function is abnormal, creatinine levels may be elevated. Because they typically have more muscle mass, men usually have higher creatinine levels than women. A normal value of creatinine is usually 50 to 100 µmol/L for women and 70 to 120 for men (roughly equivalent to the American values of 0.8 to 1.4 mg/dL).

the table summarizes the ISS and Durie-Salmon staging systems for active myeloma.

Stage	ISS	Durie-Salmon
I	ß₂ microglobulin is less than 3.5 mg/L AND Albumin is equal to or greater than 35 g/L	All of the following must be present: Hemoglobin > 105 g/L Normal serum calcium (< 2.88 mmol/L) Low serum monoclonal protein IgG < 50 g/l IgA < 30 g/l Urine light chain<4 g per 24 hrs. No bone lesions or osteoporosis
II	ß₂ microglobulin is less than 3.5 mg/L, but albumin is less than 35 g/L OR ß₂ microglobulin is between 3.5 – 5.5 mg/L, irrespective of albumin	Fitting neither Stage I nor Stage III
III	ß₂ microglobulin is equal to or greater than 5.5 mg/L	One or more of the following must be present: Hemoglobin < 85 g/L Elevated serum calcium (> 2.88 mmol/L) High M-protein production rates IgG > 70 g/L IgA > 50 g/L Urine light chain > 12 g per 24 hrs. Advanced lytic bone lesions on skeletal survey Subclassification: A. Relatively normal renal function (serum creatinine less than 180 mmol/L) B. Abnormal renal function(serum creatinine equal to or greater than 180 mmol/L)

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