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Stages of Multiple Myeloma

Medically reviewed by Todd Gersten, M.D.
Written by Kelly Crumrin
Posted on January 16, 2019

Oncologists (doctors specializing in cancer) assign a stage to multiple myeloma to express how advanced the cancer is and their prediction for how it will progress. Recommendations about myeloma treatment are based partly on the stage. Two different systems are used to stage multiple myeloma. Both systems recognize three stages and are based on the results of clinical tests rather than myeloma symptoms a person experiences.

Some doctors regard related precancerous conditions, such as monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM), as early, asymptomatic stages of multiple myeloma. However, this article deals with how cancer is staged when multiple myeloma is first diagnosed or when it relapses.

Read more about myeloma types and related disorders.

Systems for Staging Multiple Myeloma

There are two staging systems for multiple myeloma, the International Staging System (ISS) and the Durie-Salmon Staging System. Each is based on measurements of different properties.

International Staging System

The International Staging System was introduced in 2003, and many doctors consider it a more accurate assessment of the risk for multiple myeloma progression. The ISS does not take X-rays or bone lesions into account when staging multiple myeloma. Oncologists using the ISS perform a cytogenetic study to examine the genes of cancer cells for traits connected with a high risk for progression. They also measure levels of different substances found in the blood, including albumin (a common protein), beta microglobulin (protein produced by myeloma cells), and lactate dehydrogenase (an enzyme produced as cells turn glucose into energy).

Stage 1

  • Cytogenetic studies do not show high risk for progression.
  • Albumin levels are greater than 3.5 grams per deciliter.
  • Beta macroglobulin levels are less than 3.5 milligrams per liter.
  • Lactate dehydrogenase levels are normal.

Read more about stage 1 multiple myeloma.

Stage 2

  • Findings are more advanced than stage 1, but less advanced than stage 3.

Read more about stage 2 multiple myeloma.

Stage 3

  • Cytogenetic studies show a high risk for progression.
  • Beta macroglobulin levels are greater than 5.5 milligrams per liter.
  • Lactate dehydrogenase levels are elevated.

Read more about stage 3 multiple myeloma.

Durie-Salmon Staging System

First introduced in the 1970s, the Durie-Salmon staging system is still used by some doctors to stage multiple myeloma. Oncologists using the Durie-Salmon system look at X-rays and count bone lesions. They also test blood and urine to measure levels of hemoglobin (a protein that transports oxygen in the blood), calcium (a mineral released when bones are breaking down), and M proteins and light chains (abnormal fragments of antibodies made by the immune system).

Stage 1

  • X-rays are normal, or there is a solitary plasmacytoma (one bone lesion).
  • Hemoglobin is greater than 10.5 grams per deciliter.
  • Blood calcium is 12 milligrams per deciliter or less.
  • M proteins and IgG are less than 5 grams per deciliter.
  • IgA is less than 3 grams per deciliter.
  • Light chains in urine are less than 4 grams in 24 hours.

Stage 2

  • Findings are more advanced than stage 1, but less advanced than stage 3.
  • Diagnosis is stage 2A if there is no kidney failure, stage 2B if kidney failure is present.

Stage 3

  • X-rays show more than three bone lesions.
  • Hemoglobin is less than 8.5 grams per deciliter.
  • Blood calcium is greater than 12 milligrams per deciliter.
  • M proteins and IgG are greater than 7 grams per deciliter. IgA is greater than 5 grams per deciliter.
  • Light chains in urine are greater than 12 grams in 24 hours.

Re-Staging

If there is a relapse after multiple myeloma has been effectively treated, the oncologist may re-stage the cancer based on the same criteria.

Condition Guide

Posted on January 16, 2019
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Todd Gersten, M.D. is a hematologist-oncologist at the Florida Cancer Specialists & Research Institute in Wellington, Florida. Review provided by VeriMed Healthcare Network. Learn more about him here.
Kelly Crumrin is a senior editor at MyHealthTeam and leads the creation of content that educates and empowers people with chronic illnesses. Learn more about her here.

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