[KLM]

Stage 3B multiple myeloma - what is it?

by KLM on Thu Aug 17, 2017 8:00 pm

Can someone explain what Stage 3B multiple myeloma is? I can't find it anywhere.

Thanking you in advance.

[Multibilly]

Re: Stage 3B multiple myeloma - what is it?

by Multibilly on Fri Aug 18, 2017 8:31 am

Hi KLM,

Welcome to the forum.

If one was given a myeloma stage of "IIIB", it sounds like the doctor was using the older Durie-Salmon staging criteria. Durie-Salmon has largely been replaced by the newer ISS system. The older Durie-Salmon criteria are as follows:

Stage I

• Hemoglobin value 10 g/dL
• Serum calcium value normal or =12 mg/dL
• Bone x-ray, normal bone structure (scale 0) or solitary bone plasmacytoma only
• Low M-component production rate (IgG value <5 g/dL; IgA value <3 g/dL; Bence Jones protein <4 g/24 hr)

Stage II*

Neither stage I nor stage III
Neither stage I nor stage III

Stage III

One or more of the following:

• Hemoglobin value 12 mg/dL
• Advanced lytic bone lesions (scale 3)
• High M-component production rate – IgG value >7 g/dL; IgA value>5 g/dL; Bence Jones protein >12 g/24 h

Durie-Salmon sub classifications (either A or B)

A: Relatively normal renal function (serum creatinine value <2.0 mg/dL)
B: Abnormal renal function (serum creatinine value =2.0 mg/dL)

From your history, it sounds like your spouse has already undergone drug treatment and a stem cell transplant and is currently on maintenance? I'm also guessing that you are not in the USA if the maintenance treatment involved thalidomide and the doctor used the Durie-Salmon scale for staging? Has your spouse now been re-staged to Durie-Salmon IIIB while on maintenance?

In general, staging is not so important in myeloma, but rather it's how one's key numbers (M-spike, serum free light chain values, plasma cell percentages, etc) are doing and if the patient is developing any organ damage as defined by the CRAB criteria.

Hope this helps a bit.

[Ron Harvot]

Re: Stage 3B multiple myeloma - what is it?

by Ron Harvot on Fri Aug 18, 2017 12:25 pm

To add to Multibilly's comments: Staging is not nearly as important as genetic profile, as it determines if a person is high risk or not. Those that are high risk usually do not respond as well or as long to treatment. Deletion 17p is an example of a high-risk chromosome deletion that has typically led to poorer outcomes.

So someone with Stage III myeloma at standard risk could actually have a better response to treatment than someone with Stage II or even Stage I that has high-risk genetic markers.