What are the Stages of Multiple Myeloma?
Before deciding on treatment options, your doctor will need to know the
extent, or stage, of the multiple myeloma. Your doctor will look at the
results of blood tests, X-rays or other imaging tests, and bone marrow
tests to determine the stage of the cancer.
Your doctor may also schedule a positron emission tomography (PET) scan
to help determine your stage. This test scans your entire body, so it
is more helpful than a series of several different X-rays. The PET scan
shows which parts of your body are using glucose rapidly. Glucose use
is a sign of active, quickly dividing cells, such as multiple myeloma
cells. For this test, you get injected with a small amount of radioactive
glucose. Then you lie still on a table that is pushed into the PET scanner,
which rotates around you, taking pictures.
The traditional system used to stage multiple myeloma is called the
Durie-Salmon system. This system is not used as much now as it was in the past. It is based
on four different factors:
There are three different clinical stages of multiple myeloma in the Durie-Salmon
system. Stage I indicates the smallest amount of tumor, and stage III
indicates the largest amount of tumor.
Stage I. X-rays and blood tests indicate that only a small number of myeloma
cells are present in the body. Most people with this stage do not have
symptoms. Your doctor may say that you have a
low tumor burden at this stage.
Stage II. The myeloma cells have spread through the body a little bit.
Your doctor may say that you have an
intermediate tumor burden at this stage.
Stage III. X-rays and blood tests indicate that many cancer cells are present
in the body. Your doctor may say that you have a
high tumor burden at this stage.
A newer system now used by many doctors to classify multiple myeloma is the
International Staging System. This system divides myelomas into three stages based only on the blood
levels of beta-2 microglobulin and albumin.
Stage I. The beta-2 microglobulin level is less than 3.5 milligrams/liter
(mg/L) and the albumin level is 3.5 grams/deciliter (g/dL) or higher.
Stage II. Neither stage I or III, meaning that either:
The beta-2 microglobulin level is between 3.5 and 5.5 (with any albumin
The albumin is below 3.5 while the beta-2 microglobulin is less than 3.5
Stage III. The beta-2 microglobulin level is greater than 5.5.
In addition to staging, there are other factors that affect survival. Age
is important. Older people with myeloma do not live as long. Renal failure
that seems to be due to multiple myeloma will shorten the length of survival.
Certain chromosome changes can also indicate a poorer outlook. For example,
chromosome 13 changes will lower a person's chances for survival.