Durie-Salmon Staging System

What Is the Durie-Salmon Staging System?

Staging was first used in diseases like breast cancer and colon cancer by measuring the size of a solid tumor. The staging system used for solid tumors does not apply to blood-based cancers like myeloma.

In 1975, the Durie-Salmon Staging system was first to classify patients with myeloma based on the correlation between the amount of myeloma, and the damage caused by it, such as anemia, bone disease, and renal function. The following table details the stages and criteria for measuring the presence and staging of multiple myeloma. Dr. Brian G.M. Durie (1942-2025) co-founded the IMF in 1990 together with Susie Durie and myeloma patient Brian D. Novis.

Durie-Salmon System for Myeloma Staging

The following table details the Durie-Salmon staging system used for multiple myeloma.

Stage

Criteria

Measured Myeloma Cell Mass (myeloma cells in billions/m²)*

Stage 1

(low cell mass)

All of the following:

Hemoglobin value > 10 g/dl
Serum calcium value normal or <10.5 mg/dL
Bone X-ray, normal bone structure (scale 0), or solitary bone plasmactyoma only
Low M-component production rates IgG value < 5g/dL; IgA value < 3 g/dL
Urine light chain M-component on electrophoresis < 4 g/24h

600 billion*

Stage II

(intermediate
cell mass)

Fitting neither
Stage I nor Stage III

600 to 1,200 billion*

Stage III

(high cell mass)

One or more of the following:

Hemoglobin value < 8.5 g/dL
Serum calcium value > 12 mg/dL
Advanced lytic bone lesions (scale 3)
High M-component production rates IgG value > 7 g/dL; IgA value > 5 g/dL
Urine light chain M-component > 12 g/24h

>1,200 billion*

Subclassification
(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

Examples:
Stage 1A (low cell mass with normal renal function);
Stage IIB (high cell mass with abnormal renal function)

The Evolution of the Durie-Salmon Staging System

The Durie-Salmon system has evolved to meet new imaging techniques. Modern methods incorporate MRI and whole-body fluorodeoxyglucose (FDG) positron emission tomography (PET) scanning to differentiate between the amount of tumor present and other factors affecting a patient's outlook.

Challenges of the Durie-Salmon Staging System

While the Durie-Salmon system can be helpful, monitoring multiple myeloma using it presents some challenges. For example, the system overlooks some essential factors that could help predict outcomes. Due to its age and complexity, many doctors have begun using the newer International Staging System for myeloma.

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What's Next?

What Are the Most Up-To-Date Systems Used to Stage Myeloma?

Learn more about the International Staging System (ISS) and the Revised International Staging System (R-ISS).

The International Myeloma Foundation medical and editorial content team

Comprised of leading medical researchers, hematologists, oncologists, oncology-certified nurses, medical editors, and medical journalists, our team has extensive knowledge of the multiple myeloma treatment and care landscape.

Additionally, the content on this page is medically reviewed by myeloma physicians and healthcare professionals.

Last Medical Content Review: April 28, 2026