What are the Stages of Multiple Myeloma?
After someone is diagnosed with a cancer, doctors will try to determine how far the disease has progressed; this process is called staging. Staging is a way of describing where a cancer is located, if or where it has spread, and whether it is affecting other parts of the body.
Doctors use diagnostic tests to find out the cancer’s stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor decide what kind of treatment is best and can help predict a patient’s prognosis (which is the chance of recovery).
There are different stage descriptions for different types of cancer and Multiple Myeloma is unique. “Staging” at diagnosis in multiple myeloma may not be as important as other factors like the genetics of your disease or a patient’s response to therapy.
Doctors will use the cancer’s stage when referencing statistics of survival.
The Revised International Staging System (updated 2016)
Multiple myeloma is staged using the Revised International Staging System (RISS) based on 4 factors:
- The amount of albumin in the blood at diagnosis
- The amount of beta-2-microglobulin in the blood at diagnosis
- The amount of LDH in the blood at diagnosis
- The specific gene abnormalities (cytogenetics) of the cancer.
The stages of myeloma include:
- Smoldering: Non-active disorder, no symptoms.
- Stage I: Early in the disease, no symptoms.
- Stage II: The cancer is progressing and causing multiple symptoms.
- Stage III: Cancer is in multiple parts of the body and a person will experience complex symptoms.
RISS Stage I
- Serum beta-2 microglobulin is less than 3.5 (mg/L)
- AND Albumin level is 3.5 (g/dL) or greater
- AND Cytogenetics are considered “not high risk”
- AND LDH levels are normal
RISS Stage II
- Not stage I or III
RISS Stage III
- Serum beta-2 microglobulin is 5.5 (mg/L) or greater
- AND Cytogenetics are considered “high-risk”*
- AND/OR High LDH levels
*The bone marrow may be sent for tests to look at the chromosomes in the cancer cells. This test may also be called cytogenetics. Genetics are important when staging Multiple Myeloma. Certain chromosome changes can mean a poorer outlook.
- Deletions: One or both chromosomes can be deleted (Loss chromosome 17 is linked to a poorer outcome.)
- Additions: More chromosome copies can be present (gains of 1q are found in multiple myeloma but may not indicate high-risk disease.)
- Translocations: When parts of one chromosome swap places with another chromosome, it is called a translocation. Higher risk translocations include t(4;14), t(14;16) and t(14;20)
To learn more about the genetic features that can occur in multiple myeloma, click here.
Multiple myeloma specialists focus less on the staging and more on your myeloma genetics and how you respond to therapy to determine risk. To help you manage your multiple myeloma, we’ve created a new tool called HealthTree that helps you keep your myeloma genetics, treatment history and lab work in one place. We highly encourage you to explore this important resource.