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  • Plasma cell myeloma with one or more of the following: 1. Hemoglobin less than 8.5 g/dL. 2. Serum calcium greater than 12.0 mg/dL. 3. More than three lytic bone lesions. 4. High M protein production as shown by: a. IgG greater than 7.0 g/dL. b. IgA greater than 5.0 g/dL. c. Urinary kappa or lamda greater than 12.0 g/24 hours. Estimated myeloma cell mass: greater than 1.2 trillion (1012)/m2 (high burden). The following subclassification of stages is used: a. Creatinine less than 2.0 mg/dL. b. Creatinine greater than or equal to 2.0 mg/dL. Serum beta-2-microglobulin has been shown to be a reliable marker for prognosis. Since the great majority of symptomatic myeloma patients are classified as stage III by the Durie/Salmon criteria, this staging system has not proven to be very useful for identifying the patients with intermediate and poor prognosis. Note that the newer International Staging System defines stage III quite differently: Beta-2-microglobulin greater than or equal to 5.5 (median survival of 29 months). (PDQ)
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