How is multiple myeloma staged?

Updated: Mar 15, 2019
  • Author: Michael E Mulligan, MD; Chief Editor: Felix S Chew, MD, MBA, MEd  more...
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Answer

Answer

Staging

Morbidity and mortality in myeloma patients are directly related to the stage of disease at initial diagnosis. Durie and Salmon proposed the initial clinical staging system for multiple myeloma. The system is now called the Durie/Salmon PLUS system because additional information from advanced imaging modalities has been added. Radiologists should use the revised system (outlined below) to accurately stage these patients. [20, 21]

  • Stage IA – Normal skeletal survey or single lesion ≥5mm

  • Stage IB - Five focal lesions or mild diffuse spine disease

  • Stage IIA/B - Five to 20 focal lesions or moderately diffuse spine disease

  • Stage IIIA/B - More than 20 focal lesions or severe diffuse spine disease

  • Subclasses A and B (A = normal renal function, B = abnormal renal function)

Mild, moderate, and diffuse spine disease is established by MR imaging. Moderate diffuse disease is defined as vertebral body signal intensity brighter than adjacent disc on a T1-weighted sequence. Severe diffuse disease is defined as vertebral body signal intensity less than or equal to the adjacent disc on a T1-weighted sequence. Mild disease may manifest as a "salt and pepper" pattern or minimal infiltration.


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