A cancer of the plasma cells, multiple myeloma affects immune cells that collect in bone marrow. The affected plasma cells can be anywhere but tend to affect certain areas — the skull, spine, shoulders, rib cage, pelvis, and hips. Multiple myeloma is most often diagnosed in people who are older than 65. After you’re diagnosed, it’s important to determine which stage your multiple myeloma has reached. This article tells you more about what those stages mean and how they’re defined.

How multiple myeloma is staged

Multiple myeloma is diagnosed through some combination of blood, urine, imaging, and biopsy. After you receive a diagnosis, your medical provider will use blood tests to evaluate the stage your multiple myeloma has reached. These blood tests will evaluate the levels of

• serum albumin, a protein that, when low, can indicate a liver or kidney problem

• beta-2 microglobulin, which is shed by cancer cells into the bloodstream; high levels of beta-2 microglobulin indicate cancer

• serum lactate dehydrogenase (LDH), a protein found in almost all body tissues; damaged tissues release LDH, so when it turns up in the blood, it’s an indicator of tissue damage

Other tests that might be utilized to stage your multiple myeloma include blood tests to measure platelet levels and kidney function, and imaging studies to evaluate your bones.

The staging systems for multiple myeloma

Two staging systems are common for identifying multiple myeloma stages.

Durie-Salmon Staging System

The Durie-Salmon Staging System measures

• hemoglobin concentration

• level of blood calcium paired with bone lesions (identified in imaging studies)

• M protein levels in blood and urine

• kidney function

Stage 1

• a small number of myeloma cells

• hemoglobin level is 100 g/L or more

• blood calcium level is normal (less than 2.8 mmol/L)

• no areas of bone damage or a solitary 

  plasmacytoma

   of the bone

• IgG level less than 50 g/L

• IgA level less than 30 g/L

• urine M-protein level less than 4 g 

Stage 2

Between stage 1 and stage 3

Stage 3

• large number of myeloma cells present

• hemoglobin level less than 85 g/L

• blood calcium level greater than 2.8 mmol/L

• advanced bone lesions

• IgG level is more than 70 g/L

• IgA level is more than 50 g/L

• urine M-protein level is more than 12 g 

Substages of Durie-Salmon

• substage A: normal kidney function; creatinine level less than 180 µmol/L

• substage B: abnormal kidney function; creatinine level is 180 µmol/L or more

International Staging System

The International Staging System identifies the stage based on the blood levels of two proteins: beta-2 microglobulin and albumin.

Stage 1

• the level of the protein called beta-2 microglobulin is less than 3.5 milligrams per liter (mg/L)​

• level of albumin in the blood is more than 3.5 grams per decilitre (g/dL)

• normal LDH level

• low-risk cytogenetics

Stage 2

• level of beta-2 microglobulin is between 3.5 and 5.5 mg/L, with any albumin level 

  OR 

  the level of beta-2 microglobulin is less than 3.5 mg/L and the level of albumin is less than 3.5 g/dL 

• normal LDH

• low-risk cytogenetics

Stage 3 

• level of beta-2 microglobulin is more than 5.5 mg/L 

• high LDH level

• high-risk cytogenetics

Multiple myeloma’s earliest stages

Two myeloma-related conditions may be revealed by testing even where symptoms aren’t present. These are:

• Monoclonal gammopathy of undetermined significance (MGUS)

   is identified when a patient has a small number of atypical proteins in the bone marrow. It typically doesn’t produce symptoms, but it can be a precursor to multiple myeloma, which means it needs to be monitored.

• Smoldering, or asymptomatic, myeloma

   occurs when a patient has more atypical cells than in the MGUS stage but not enough to damage the body or produce multiple myeloma symptoms (although some patients experience anemia at this stage). Like MGUS, it requires monitoring, but it is more likely than MGUS to progress into symptomatic myeloma.

“So a few months ago I had my first bone density done (I am 51) and I was found to have moderate osteoporosis in my lumbar spine. The rheumatologist ran blood work to rule out possible causes and now I have moved on to an oncologist who has diagnosed me with smoldering multiple myeloma. Is there anyone else who has or is currently struggling with this? I am so scared!”

Multiple myeloma stages 1-3 

The symptomatic stages of multiple myeloma progress from 1-3, with stage 1 being the earliest and stage 3 being the most advanced. In the earliest stage, few myeloma cells are found in the body, and they haven’t caused significant damage. As myeloma progresses, the atypical cells are found in more places, and lesions appear on the bones. Symptoms are present as early as stage 1 and include the following:

• bone pain

• fatigue

• frequent infections

• reduced kidney function

• anemia

Treatment is required when a patient reaches the earliest stage but is not as aggressive as at other stages and often includes a combination of drugs — most often chemotherapies or monoclonal antibodies.

Living with multiple myeloma

Research and evolving treatment options are improving the prognosis for multiple myeloma patients. Whatever the particulars of your own situation mean for your treatment, having a support system can help you cope. Join the Inspire Myeloma Support Community to connect with others living with multiple myeloma.

Sources

• https://medlineplus.gov/multiplemyeloma.html

• https://www.oregoncancer.com/multiple-myeloma/detection-diagnosis

• https://www.oregoncancer.com/multiple-myeloma/staging

• https://www.myeloma.org/durie-salmon-staging

• https://my.clevelandclinic.org/health/diseases/22826-plasmacytoma

• https://www.cancer.org/cancer/types/multiple-myeloma/detection-diagnosis-staging/staging.html

• https://uihc.org/health-topics/multiple-myeloma-stages-and-types

• https://www.mymyelomateam.com/resources/stage-1-multiple-myeloma-what-to-expect

• https://www.cancer.org/cancer/types/multiple-myeloma/detection-diagnosis-staging/staging.html

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4846284/

Disclaimer

Member comments have been lightly edited for length and clarity. This content is for general informational purposes only and does not necessarily reflect the views and opinions of any organization or individual. The content should not be used as a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider about any questions you may have regarding a medical condition.