Multiple Myeloma Diagnostic Criteria

Helps diagnose MM based on blood and bone marrow characteristics.

In the text below the calculator there is more information about the original study and about multiple myeloma staging.

The Durie and Salmon multiple myeloma diagnostic criteria helps diagnose MM based on several patient parameters extracted from blood and urine tests and bone marrow biopsy.

There are four major criteria and four minor criteria that are verified against the two positive diagnostic rules:

■ At least 1 major criteria and 1 minor criteria;

■ No major criteria but at least 3 minor criteria.

The above MM diagnostic criteria was created by Durie and Salmon in 1975. It is based on bivariate correlation and multivariate regression analysis of the clinical features and myeloma cell mass of 71 patients.

The study also resulted in a myeloma staging model with three grades, that is based on haemoglobin, serum calcium, bone x-ray findings and low M-component production rate.

Major Diagnostic Criteria

Plasmacytoma on tissue biopsy

Bone marrow plasmacytosis of > 30%

M Protein: IgG > 3.5 g/L; IgA > 2.0 g/L

Urinary kappa or lambda chain excretion of > 1g / 24 hours in absence of amyloidosis

Minor Diagnostic Criteria

Marrow plasmacytosis of 10 - 30%

Lytic bone lesions

Evidence of a monoclonal protein but lessor amounts than above

Hypoglobulinemia of normal proteins: IgM < 500 mg/L, IgA < 1 g/L or IgG < 6g/L

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MM diagnostic criteria

This is a diagnostic criteria for patients suspected of multiple myeloma, that is based on a series of blood and urine determinations and on presence of malignant plasma cell tumor growing.

The major and minor criteria from the model are described in the following table:

Major Criteria
Plasmacytoma on tissue biopsy	Presence of a malignant plasma cell tumor growing within the tissue.
Bone marrow plasmacytosis of >30%	Increased number of plasma cells in the bone marrow.
M Protein: IgG >3.5 g/L; IgA >2.0 g/L	In myeloma the body produces IgG, IgA and IgD antibodies.
Urinary kappa or lambda chain excretion of more than 1 g / 24 hours in absence of amyloidosis	Presence of light chains (polypeptides synthesized by plasma cells which form part of immunoglobulins) in urine in the absence of abnormal proteinuria.
Minor Criteria
Marrow plasmacytosis of 10-30%	Presence of plasma cells in bone marrow of little less than 30%.
Lytic bone lesions	Depleted areas found in otherwise dense bone, which are indicative of bone metastasis of lung and breast cancer.
Evidence of a monoclonal protein but lessor amounts than above	Presence of M protein, that is produced by plasma cells.
Hypoglobulinemia of normal proteins: IgM <500 mg/L, IgA <1 g/L or IgG <6g/L	Abnormally low levels of globulin in the blood.

Positive multiple myeloma diagnosis can be put if either of the following two is met:

■ 1 Major Criteria and 1 Minor Criteria;

■ 0 Major Criteria and 3 Minor Criteria.

Durie and Salmon staging system

Beside the diagnostic criteria, the two authors have also devised a multiple myeloma classification system:

MM staging	Description
Stage I (all present)	Hemoglobin value >100 g/L (>10 g/dL) Serum calcium value normal or 3.0 mmol/L or less (12 mg/dL or less) Bone x-ray: normal bone structure or solitary bone plasmacytoma only Low M-component production rate (IgG value <50 g/L [<5 g/dL]; IgA value <30,000 mg/L [<3 g/dL]; Bence Jones protein <4 g/24 hours).
Stage II	(neither stage I nor stage III)
Stage III (one or more present) Stage IIIA – normal renal function Stage IIIB – abnormal renal function	Hemoglobin value <85 g/L (<8.5 g/dL) Serum calcium value >3.0 mmol/L (>12 mg/dL) Advanced lytic bone lesions (>3) High M-component production rate (IgG value >70 g/L [>7 g/dL]); IgA value >50,000 mg/L [>5 g/dL]; Bence Jones protein >12 g/24 hours).

About the study

The above MM diagnostic criteria was created by Durie and Salmon in 1975, after a study in which the presenting clinical features of 71 patients with multiple myeloma were correlated with myeloma cell mass (myeloma cells X 10¹²/m² of body surface area).

Bivariate correlation and multivariate regression analyses showed that there are several criteria that can accurately predict the myeloma cell mass:

A) Extent of bone lesions;

B) Hemoglobin level;

C) Serum calcium level;

D) M-component levels in serum and urine.

The results from the study were synthesized to produce reliable and useful diagnosis criteria and a clinical staging system with three tumor cell mass levels.

Multiple myeloma symptoms and stages

MM is characterized by an accumulation of plasma cells in the bone marrow, that produces a monoclonal protein which causes organ and tissue impairment. MM is caused most commonly by an incorrect genetic sequence during the terminal differentiation of B lymphocytes into plasma cells.

Symptoms of bone marrow cancer include:

■ Spinal cord/ Nerve compression;

■ Anemia (normochromic, normocytic);

■ Hypercalcemia;

■ Bleeding/ Bruising;

■ Bone pain (e.g. back pain);

■ Pathological fractures;

■ Dehydration;

■ Renal impairment;

■ Recurrent bacterial infections.

Diagnosis is put following blood, urine and imagistic determinations. Subsequently, bone marrow aspirate and trephine biopsy with the phenotyping of plasma cells, take place.

There are other diagnostic models with similar criteria, such as the Myeloma Working Group diagnostic criteria or the International Staging System (ISS). The former supports diagnosis but also provides a multiple myeloma life expectancy prognosis.

This ISS is based on serum beta2-microglobulin (Sbeta2M), serum albumin, platelet count, serum creatinine and patient age.

The table below shows the ISS stages, their characteristics and median survival:

Stage	Characteristics	Median survival
Stage I	Sbeta2M <3.5 mg/L Serum albumin ≥3.5 g/dL	62 months
Stage II	Neither stage I nor III	44 months
Stage III	Sbeta2M ≥5.5 mg/L	29 months

Original source

Durie BG, Salmon SE. A clinical staging system for multiple myeloma. Correlation of measured myeloma cell mass with presenting clinical features, response to treatment, and survival. Cancer. 1975; 36(3):842-54.

Other references

1. Kyle RA, Rajkumar SV. Criteria for diagnosis, staging, risk stratification and response assessment of multiple myeloma. Leukemia. 2009; 23(1): 3–9.

2. Greipp PR, San Miguel J, Durie BG, Crowley JJ, Barlogie B, Bladé J, Boccadoro M, Child JA, Avet-Loiseau H, Kyle RA, Lahuerta JJ, Ludwig H, Morgan G, Powles R, Shimizu K, Shustik C, Sonneveld P, Tosi P, Turesson I, Westin J. International staging system for multiple myeloma. J Clin Oncol. 2005; 23(15):3412-20.

Specialty: Oncology

Objective: Diagnosis

Type: Criteria

No. Of Criteria: 8

Year Of Study: 1975

Article By: Denise Nedea

Published On: June 13, 2017 · 11:31 AM

Last Checked: June 13, 2017

Next Review: June 13, 2023