What are the limitations of the durie salmon staging?

While the durie salmon staging is highly validated, it should not replace clinical judgment. OpiCalc provides the latest evidence-based limitations for the durie salmon staging to ensure safe bedside use and optimal diagnostic accuracy.

How does the durie salmon staging compare to other Hematology scores?

The durie salmon staging is a gold-standard diagnostic tool. OpiCalc provides side-by-side clinical guidance to help clinicians choose the most specific evidence-based tool for their patient's presentation.

Is the durie salmon staging free to use?

Yes. OpiCalc provides the durie salmon staging completely ad-free and optimized for mobile bedside use, ensuring you can calculate medical risk swiftly and without distraction.

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Durie-Salmon Staging (historical)

Historical Staging: The Durie-Salmon system classifies myeloma based on estimated tumor cell mass. Note: Modern clinical practice primarily uses the Revised-ISS (R-ISS).

Laboratory Parameters

Haemoglobin (g/dL)

Serum Calcium (mg/dL)

Creatinine (mg/dL)

Bone & Protein

Bone X-Ray Findings

IgG (g/dL)

IgA (g/dL)

BJ (g/24h)

Guidelines & Evidence

Clinical Details

Section 1

When to Use

Historical classification and staging of Multiple Myeloma.

Estimating myleoma cell mass based on clinical and laboratory parameters.

Educational or retrospective data analysis (note: largely superseded by R-ISS).

Patient Population

Patients with confirmed Multiple Myeloma. Historically used to differentiate low, intermediate, and high tumor burden.

When Not to Rely on This Score Alone

Modern prognostication — the Revised International Staging System (R-ISS) is the current gold standard, incorporating LDH and cytogenetics.

Monitoring response — use IMWG response criteria (e.g., sCR, VGPR, PR) rather than staging systems.

Section 2

Formula & Logic

Stage I (Low Cell Mass)

Haemoglobin > 10 g/dL

Serum Calcium < 12 mg/dL

Normal bone x-ray or solitary plasmacytoma

Low M-protein: IgG < 5 g/dL, IgA < 3 g/dL, Bence Jones < 4g/24h

Stage III (High Cell Mass)

Haemoglobin < 8.5 g/dL

Serum Calcium > 12 mg/dL

Advanced lytic bone lesions (≥ 3)

High M-protein: IgG > 7 g/dL, IgA > 5 g/dL, Bence Jones > 12g/24h

Stage II (Intermediate)

Neither Stage I nor Stage III.

Substaging (Renal Function)

Substage	Criteria
A	Serum Creatinine < 2.0 mg/dL
B	Serum Creatinine ≥ 2.0 mg/dL

Section 3

Pearls/Pitfalls

Historical Context

The Durie-Salmon system (1975) was revolutionary because it correlated clinical symptoms with actual myeloma cell burden. However, it was limited by the need for diagnostic x-rays and subjective bone lesion counts, which are less sensitive than modern low-dose CT or MRI.

Section 4

Evidence Appraisal

Primary Score

A clinical staging system for multiple myeloma. Correlation of measured myeloma cell mass with presenting clinical features, response to treatment, and survival.

Durie BG et al. • Cancer. 1975;36(3):842-54.

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Section 5

Literature

Development

Developed by Brian Durie and Sydney Salmon at the University of Arizona. It dominated myeloma staging for three decades until the ISS (2005) gained prominence.

Last Comprehensive Review: 2026

Related Hematology Tools

Binet / Rai Staging

iwCLL Response Criteria

Revised Response Criteria

PCNSL MSKCC Score

ISS

R-ISS

IMWG Response Criteria

MRD Assessment Threshold Interpreter

mSMART 3.0

SLiM-CRAB Criteria

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