What is the international staging system for multiple myeloma (MM)?

Updated: Sep 30, 2019
  • Author: Dhaval Shah, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

The International Staging System of the International Myeloma Working Group is also based on three stages.

Stage I consists of the following:

  • Beta-2 microglobulin ≤3.5 g/dL and albumin ≥3.5 g/dL
  • CRP ≥4.0 mg/dL
  • Plasma cell labeling index < 1%
  • Absence of chromosome 13 deletion
  • Low serum IL-6 receptor
  • Long duration of initial plateau phase

Stage II consists of the following:

  • Beta-2 microglobulin level ≥3.5 to < 5.5 g/dL,  or
  • Beta-2 microglobulin < 3.5 g/dL and albumin < 3.5 g/dL

Stage III consists of the following:

  • Beta-2 microglobulin of 5.5 g/dL or more

Median survival is as follows:

  • Stage I, 62 months
  • Stage II, 44 months
  • Stage III, 29 months

In the 2015 revision of the International Staging System (ISS) , stage I comprises all of the following:

  • ISS stage I  
  • Standard-risk chromosomal abnormalities by fluorescence in situ hybridization (FISH)(ie, no high-risk)
  • Serum lactate dehydrogenase (LDH) level at or below the upper limit of normal

Stage II consists of all other possible combinations of ISS criteria, chromosomal abnormalities, and LDH other than those of stage I or III.

Stage III consists of the following:

  • ISS stage III  and 
  • High-risk chromosomal abnormalities by FISH (ie, presence of del(17p) and/or translocation t(4;14) and/or translocation t(14;16))  or
  • Serum LDH level above the upper limit of normal          

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