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Figure 4:  Multiple Myeloma Staging Criteria


International Myeloma Staging System

Monoclonal gammopathy of undetermined significance  (MGUS)=M-protein found in blood without other diagnostic criteria for multiple


Stage I: All of the following:

  • Hemoglobin >10 g/dL.
  • Normal serum calcium.
  • Normal bone structure.
  • Low M-protein production as shown by:
    • IgG <5.0 g/dL.
    • IgA <3.0 g/dL.
    • Urinary kappa (κ) or lambda (λ) light chains <4 g/24 hours.
    • Low myeloma cell mass (<0.6 X 1012) cells/m2.

Stage I multiple myeloma:

  • Beta-2-microglobulin <3.5.
  • Albumin ≥3.5.

Stage II:  Disease neither stage I nor stage III:

  • Intermediate myeloma cell mass: 0.6 to 1.2 trillion (1012)/m2

Stage II multiple myeloma:

  • Beta-2-microglobulin <3.5 and albumin <3.5, or
  • Beta-2-microglobulin 3.5 to <5.5.

Stage III means 1 or more of the following:

  • Hemoglobin <8.5 g/dL.
  • Serum calcium >12.0 mg/dL.
  • More than 3 lytic bone lesions (>75%).
  • High M-protein production as shown by:
    • IgG >7.0 g/dL.
    • IgA >5.0 g/dL.
    • Urinary kappa (κ) or lambda (λ) >12.0 g/24 hours.
    • Estimated myeloma cell mass: >1.2 trillion (1012)/m2 (high burden).

Stage III multiple myeloma:

  • Beta-2-microglobulin ≥5.5

Subclassified based upon renal function:

  1. Serum creatinine <2 mg/dL.
  2. Serum creatinine ≥2 mg/dL.

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