Sandbox:Haytham
- Based on stage, patients are classified into standard (average) and high risk, with standard risk accounting for most patients (about half to two-thirds) and high risk accounting for the remainder. Standard risk patients are those patients aged over 3 years, with 1.5 cm2 residual tumour on immediatepostoperative imaging and/or metastatic disease (leptomeningeal seeding, M1e3) or unfavourable histopa-thology . M4 disease at the time of first diagnosis is virtually never seen.
World Health Organization 2007 (WHO) classification
classic:
dense sheet like growth of cells
hyperchromatic round-to-oval nuclei
increased mitotic activity
conspicuous apoptosis
neuroblastic or Homer-Wright rosettes (neoplastic cell nuclei disposed in a radial arrangement around fibrillary processes) are common features
necrosis is less common
desmoplastic:
more common in adults
-nce termed "circumscribed arachnoidal cerebellar sarcoma"
extensively nodular with neuronal differentiation:
usually in children less than 3 years of age
also known as cerebellar neuroblastoma
"grapelike" macroscopic nodularity
intranodular:
cellular uniformity
fine fibrillary matrix
-ccasional mature ganglion cells
large cell / anaplastic:
rarest histologic subtype
high mitotic activity and pleomorphism
large round nuclei with variable eosinophilic cytoplasm
not distinguishable on imaging from other types
haemorrhage and necrosis is common
First published in 1975, the Durie-Salmon staging system  is still in use, but has largely been superseded by the simpler ISS:
- stage 1: all of
Hb > 10g/dL
normal calcium
Skeletal survey: normal or single plasmacytoma or osteoporosis
Serum paraprotein level < 5 g/dL if IgG, < 3 g/dL if IgA
Urinary light chain excretion < 4 g/24h
- Hb > 10g/dL
- normal calcium
- Skeletal survey: normal or single plasmacytoma or osteoporosis
- Serum paraprotein level < 5 g/dL if IgG, < 3 g/dL if IgA
- Urinary light chain excretion < 4 g/24h
- stage 2: fulfilling the criteria of neither 1 nor 3
- stage 3: one or more of
Hb < 8.5g/dL
high calcium > 12mg/dL
Skeletal survey: 3 or more lytic bone lesions
Serum paraprotein >7g/dL if IgG, > 5 g/dL if IgA
Urinary light chain excretion > 12g/24h
- Hb < 8.5g/dL
- high calcium > 12mg/dL
- Skeletal survey: 3 or more lytic bone lesions
- Serum paraprotein >7g/dL if IgG, > 5 g/dL if IgA
- Urinary light chain excretion > 12g/24h
The table below lists the genetic risk factors for multiple myeloma:
The table below lists the risk factors for multiple myeloma:
The table below lists the genetic risk factors for multiple myeloma:
The table below lists common prognostic factors for multiple myeloma:

# Stratification of Treatment Based on Transplant Eligibility

## Transplant-Eligible Patients
- According to the Myeloma Mayo Stratification of Myeloma and Risk-Adapted Therapy (Myeloma M-SMART), medical therapy for transplant-eligible patients is individualized based on the patient risk.
- The algorithm is shown below:

## Transplant-Ineligible Patients
- According to the Myeloma Mayo Stratification of Myeloma and Risk-Adapted Therapy (Myeloma M-SMART), medical therapy for transplant-ineligible patients is also individualized based on the patient risk.
- The algorithm is shown below:
-  SEER Stat Fact Sheets: Myeloma. Surveillance, Epidemiology, and End Results Program Turning Cancer Data Into Discovery. Accessed on September ,20 2015
-  Multiple myeloma. The American Cancer Society (2015)  Accessed on September, 20 2015
-  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;36:842854. PMID 1182674.
-  Jump up to: 4.0 4.1 Parry S, Win AK, Parry B, Macrae FA, Gurrin LC, Church JM;  et al. (2011). "Metachronous colorectal cancer risk for mismatch repair gene mutation carriers: the advantage of more extensive colon surgery". Gut. 60 (7): 9507. doi:10.1136/gut.2010.228056. PMC 3848416. PMID 21193451.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link) CS1 maint: PMC format (link) .mw-parser-output cite.citation{font-style:inherit}.mw-parser-output q{quotes:"\"""\"""'""'"}.mw-parser-output code.cs1-code{color:inherit;background:inherit;border:inherit;padding:inherit}.mw-parser-output .cs1-lock-free a{background:url("")no-repeat;background-position:right .1em center}.mw-parser-output .cs1-lock-limited a,.mw-parser-output .cs1-lock-registration a{background:url("")no-repeat;background-position:right .1em center}.mw-parser-output .cs1-lock-subscription a{background:url("")no-repeat;background-position:right .1em center}.mw-parser-output .cs1-subscription,.mw-parser-output .cs1-registration{color:#555}.mw-parser-output .cs1-subscription span,.mw-parser-output .cs1-registration span{border-bottom:1px dotted;cursor:help}.mw-parser-output .cs1-hidden-error{display:none;font-size:100%}.mw-parser-output .cs1-visible-error{display:none;font-size:100%}.mw-parser-output .cs1-subscription,.mw-parser-output .cs1-registration,.mw-parser-output .cs1-format{font-size:95%}.mw-parser-output .cs1-kern-left,.mw-parser-output .cs1-kern-wl-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right,.mw-parser-output .cs1-kern-wl-right{padding-right:0.2em}
-  Press Releases. Compugen (2015) Accessed on September, 20th 2015
-  Multiple myeloma. Radiopaedia (2015) Accessed on September, 20th 2015
-  Multiple myeloma. The American Cancer Society (2015)  Accessed on September, 20 2015
-  Multiple myeloma. Wikipedia (2015)#Pathophysiology Accessed on September, 20th 2015
-  Multiple myeloma. The American Cancer Society (2015)  Accessed on September, 20 2015
-  Seer stat fact sheet. National cancer institute (2015) Accessed on September, 20th 2015
-  Multiple myeloma. Radiopaedia (2015) Accessed on September, 20th 2015
-  Multiple myeloma. The American Cancer Society (2015)  Accessed on September, 20 2015
-  Multiple myeloma. MedlinePlus (2015) Accessed on Septmeber, 20th 2015
-  Multiple myeloma. The American Cancer Society (2015)  Accessed on September, 20 2015
-  Bourguet, CC.; Grufferman, S.; Delzell, E.; DeLong, ER.; Cohen, HJ. (1985). "Multiple myeloma and family history of cancer. A case-control study". Cancer. 56 (8): 21339. PMID 4027940. Unknown parameter |month= ignored (help)
-  Multiple myeloma. Wikipedia (2015)#Pathophysiology Accessed on September, 20th 2015
-  Koura DT, Langston AA (2013). "Inherited predisposition to multiple myeloma". Ther Adv Hematol. 4 (4): 2917. doi:10.1177/2040620713485375. PMC 3734900. PMID 23926460.CS1 maint: PMC format (link)
-  Multiple myeloma. The American Cancer Society (2015)  Accessed on September, 20 2015
-  Multiple myeloma. MedlinePlus (2015) Accessed on Septmeber, 20th 2015
-  Multiple myeloma. The American Cancer Society (2015)  Accessed on September, 20 2015
-  Gallagher, RP.; Spinelli, JJ.; Elwood, JM.; Skippen, DH. (1983). "Allergies and agricultural exposure as risk factors for multiple myeloma". Br J Cancer. 48 (6): 8537. PMID 6652026. Unknown parameter |month= ignored (help)
-  Multiple myeloma. MedlinePlus (2015) Accessed on Septmeber, 20th 2015
-  Multiple myeloma. The American Cancer Society (2015)  Accessed on September, 20 2015
-  Multiple myeloma. MedlinePlus (2015) Accessed on Septmeber, 20th 2015
-  Multiple myeloma. The American Cancer Society (2015)  Accessed on September, 20 2015
-  Multiple myeloma. Canadian cancer society (2015) Accessed on September, 20th 2015
-  Multiple myeloma. Canadian cancer society (2015) Accessed on September, 20th 2015
-  Multiple myeloma. Canadian cancer society (2015) Accessed on September, 20th 2015
-  Multiple myeloma. Canadian cancer society (2015) Accessed on September, 20th 2015
-  Multiple myeloma. Canadian cancer society (2015) Accessed on September, 20th 2015
-  Multiple myeloma. Wikipedia (2015)#Prognosis Accessed on September, 20th 2015
-  Plasma cell neoplasm. Cancer.gov (2015)#link/_40_toc
-  Multiple myeloma. Canadian cancer society (2015) Accessed on September, 20th 2015
-  Multiple myeloma. Canadian cancer society (2015) Accessed on September, 20th 2015
-  Multiple myeloma. Canadian cancer society (2015) Accessed on September, 20th 2015
-  Multiple myeloma. Canadian cancer society (2015) Accessed on September, 20th 2015
-  Multiple myeloma. Canadian cancer society (2015) Accessed on September, 20th 2015
-  Multiple myeloma. Canadian cancer society (2015) Accessed on September, 20th 2015
-  Jump up to: 39.0 39.1 Mikhael JR, Dingli D, Roy V, Reeder CB, Buadi FK, Hayman SR;  et al. (2013). "Management of newly diagnosed symptomatic multiple myeloma: updated Mayo Stratification of Myeloma and Risk-Adapted Therapy (mSMART) consensus guidelines 2013". Mayo Clin Proc. 88 (4): 36076. doi:10.1016/j.mayocp.2013.01.019. PMID 23541011.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)