The role of anatomic and functional staging in myeloma: description of Durie/Salmon plus staging system.

Staging is the cornerstone of baseline myeloma evaluation. New imaging techniques such as magnetic resonance imaging (MRI), whole body FDG-PET scanning and whole body CT (combined with PET directly or by fusion) offer the opportunity to precisely stage patients by anatomic and functional techniques. The new Durie/Salmon PLUS staging system integrates these new imaging techniques into a new generation of anatomic and functional myeloma staging. It is possible to discriminate between the impact of tumour burden (myeloma cell mass) and other prognostic factors. This refined classification by stage and prognostic category is increasingly important in clinical trials. The value of clinical staging in patient management is emphasized both in discrimination of early disease status and clearer identification of poorer risk of Stage II and III disease. Wider use of newer imaging will undoubtedly enhance analysis of new trials incorporating novel agents.