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The stages of myeloma

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This page tells you about staging myeloma. You can find the following information

 

A quick guide to what's on this page

The stages of myeloma

The stage of a cancer tells your doctor how far it has grown or spread. This information helps your specialist plan the treatment that is most appropriate for you. Doctors use the International Staging System (ISS) to help them predict how your myeloma might respond to treatment.

Doctors also look at whether your myeloma is affecting your body tissues and organs, and causing symptoms. They then group you as having either no symptoms (asymptomatic or smouldering myeloma) or myeloma with symptoms (symptomatic myeloma). 

Myeloma can respond very well to treatment and go into remission. This means that there is no sign of active myeloma in your body. Or the abnormal proteins produced by the myeloma can remain at the same level. This is called stable disease. 

Relapsed multiple myeloma

If the myeloma comes back or the protein levels rise again, it is called relapsed myeloma or recurrent myeloma.

 

CR PDF Icon You can view and print the quick guides for all the pages in the treating myeloma section.

 

 

Staging myeloma

The stage of a cancer tells your doctor how far it has grown or spread. The tests and scans you have when diagnosing your myeloma give some information about the stage. This information helps your specialist plan the treatment that is most appropriate for you.

The International Staging System

The International Staging System (ISS) looks at the results of 2 blood tests as part of staging. These blood tests are ß2-microglobulin and albumin. The ISS has 3 stages

  • Stage 1 – The level of the protein called beta 2 microglobulin (ß2-microglobulin or ß2-M) is less than 3.5 milligrams per litre (mg/L). And the level of albumin in the blood is more than 3.5 grams per decilitre (g/dL)
  • Stage 2 – The level of ß2-M is between 3.5 and 5.5 mg/L, with any albumin level. Or the level of ß2-M is less than 3.5 mg/L and the level of albumin is less than 3.5 g/dL
  • Stage 3 – The level of ß2-M is more than 5.5 mg/L

Doctors can use this system to help them predict how you might respond to treatment.

 

How doctors classify myeloma

Doctors simplify the way they classify myeloma to help them know which myeloma treatment you need. To do this they look at whether your myeloma is affecting your body tissues and organs, and causing symptoms. The symptoms they check for are called CRAB, which stands for

  • Calcium (high levels)
  • Renal (kidney damage)
  • Anaemia (low levels of red blood cells)
  • Bone damage

Doctors then group you as having either

Myeloma without symptoms (asymptomatic myeloma)

Asymptomatic myeloma is also called smouldering or indolent myeloma. This means you don't have symptoms but have

  • A level of paraprotein in your blood that is more than 30 g/L
  • A level of abnormal plasma cells in your bone marrow that is between 10% and 60%
  • No related organ or tissue damage

You do not normally have treatment for asymptomatic myeloma. But your doctor will want to monitor you at least every 3 months for any symptoms. Asymptomatic myeloma eventually progresses to symptomatic myeloma, but your doctor cannot say when this will happen. The risk of progression is highest in the first 5 years. 

Overall, 10 out of 100 people with asymptomatic myeloma (10%) develop symptomatic myeloma every year for the first 5 years. About 3 out of 100 people (3%) develop symptomatic myeloma every year for the next 5 years. And 1 out of 100 people (1%) develop symptomatic myeloma every year after that.

Myeloma with symptoms (symptomatic myeloma)

If you have symptomatic myeloma you need to have treatment. Symptomatic myeloma means you have

  • Abnormal plasma cells in your bone marrow, or plasmacytoma (an area of abnormal plasma cells in the bone or soft tissue)
  • Damage to tissues or organs (such as bone problems, high calcium levels, kidney problems or low levels of red blood cells – anaemia)

And any one or more of the following

  • More than 60% abnormal plasma cells in your bone marrow
  • A serum free light chain ratio of more than 100
  • More than 1 lesion (involving your bone or bone marrow) on an MRI scan
 

Relapsed myeloma

Myeloma can respond very well to treatment and go into remission. Remission means that there is no sign of active disease in your body. Or the abnormal proteins can remain at the same level (plateau). This is called stable disease. But the myeloma nearly always comes back or the protein level rises again in time. It is then called relapsed myeloma or recurrent myeloma.

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Updated: 19 December 2015