What is the Salmon-Durie classification of multiple myeloma (MM)?

Updated: Jul 15, 2019
  • Author: Dhaval Shah, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

The Salmon-Durie classification of MM is based on three stages and additional subclassifications.

In stage I, the MM cell mass is less than 0.6 × 1012 cells/m2, and all of the following are present:

  • Hemoglobin value >10 g/dL
  • Serum calcium value < 12 mg/dL (normal)
  • Normal bone structure (scale 0) or only a solitary bone plasmacytoma on radiographs
  • Low M-component production rates (IgG value < 5 g/dL, IgA value < 3 g/dL, urine light-chain M component on electrophoresis < 4 g/24 h)

In stage II, the MM cell mass is 0.6-1.2 × 1012 cells/m2 or more. The other values fit neither those of stage I nor those of stage III.

In stage III, the MM cell mass is >1.2 × 1012 cells/m2, and all of the following are present:

  • Hemoglobin value < 8.5 g/dL
  • Serum calcium value >12 mg/dL
  • Advanced lytic bone lesions (scale 3) on radiographs
  • High M-component production rates (IgG value greater than 7 g/dL, IgA value greater than 5 g/dL, urine light-chain M component on electrophoresis greater than 12 g/24 h)

Subclassification A includes relatively normal renal function (serum creatinine value < 2 mg/dL), whereas subclassification B includes abnormal renal function (serum creatinine value > 2 mg/dL)

Median survival is as follows:

  • Stage I, >60 months
  • Stage II, 41 months
  • Stage III, 23 months

Disease in subclassification B has a significantly worse outcome (eg, 2-12 mo survival in 4 separate series).


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