Multiple Myeloma Staging

During the process of diagnosis, doctors can determine the amount of cancer in your body and the amount of damage caused by myeloma cells. Based on these factors, you are diagnosed as having either stage I, stage II or stage III multiple myeloma.

Blood Tests for Multiple Myeloma Staging

Multiple myeloma staging is based on the results of two blood tests that measure your blood levels of beta-2-microglobulin and albumin. Beta-2-microglobulin is a small protein located on the surface of many of your body’s cells, including plasma cells.

Albumin is a protein produced by the liver that helps transport small molecules such as calcium, progesterone and medication particles through your blood. Albumin also prevents the blood vessels from leaking fluid into surrounding tissues. In the staging of myeloma, more advanced stages of the disease are characterized by an increased amount of beta-2-microglobulin and a decreased amount of albumin.

Multiple Myeloma Stages: International Staging System

The International Staging System (ISS) is an initiative involving almost 20 myeloma institutions from around the world. The ISS allows doctors to predict how patients might respond to treatment. It replaces the older, more complicated Durie-Salmon staging system and outlines the following multiple myeloma stages:

  • Stage I: Blood level of beta-2-microglobulin is less than 3.5 mg per liter. Blood level of albumin is greater than or equal to 3.5 g per deciliter. Myeloma tumor amount is low.
  • Stage II: Blood level of beta-2-microglobulin is less than 3.5 mg per liter and albumin is less than 3.5 g per deciliter or blood level of beta-2-microglobulin is between 3.5 and 5.5 mg per liter (regardless of albumin level). Myeloma tumor amount is higher.
  • Stage III: Blood level of beta-2-microglobulin is greater than or equal to 5.5 mg per liter (regardless of albumin level). Myeloma tumor amount is high.

A fourth category–known as “smoldering” or “asymptomatic” myeloma–is characterized by an increased number of plasma cells in the bone marrow without the presence of multiple myeloma symptoms. It can take several years for smoldering myeloma to develop into stage I myeloma. Until that time, treatment isn’t necessary.

Multiple Myeloma Prognosis

The American Cancer Society (2010) has published the median survival rates for each of the multiple myeloma stages. These are:

  • Stage I: 62 months
  • Stage II: 44 months
  • Stage III: 29 months.

Median survival refers to the time it takes for half of multiple myeloma patients to pass away from the time they began treatment. This means that half of multiple myeloma patients actually live beyond the median survival rates and people with smoldering myeloma may live several years longer.

The American Cancer Society offers two caveats to their median survival rates. First, average survival rates cannot predict the multiple myeloma prognosis for every individual. Secondly, the patients who were evaluated to come up with the statistics were treated 5 to 25 years ago. Since then, more advanced methods of treatment have become available. Therefore, the general multiple myeloma prognosis is likely to be better than what these statistics suggest.

Resources

American Cancer Society. (2010). Survival rates by stage. Retrieved October 1, 2010, from http://www.cancer.org/Cancer/MultipleMyeloma/DetailedGuide/multiple-myeloma-survival-rates

Cancer Research UK. (n.d.). The stages of myeloma. Retrieved October 1, 2010, from http://www.cancerhelp.org.uk/type/myeloma/treatment/the-stages-of-myeloma

International Myeloma Foundation. (2008). International staging system (ISS). Retrieved October 1, 2010, from http://myeloma.org/ArticlePage.action?tabId=1&menuId=149&articleId=889&aTab=-1&gParentType=menuitem&gParentId=149&parentIndexPageId=48&parentCategoryId=442

National Cancer Institute. (2008). Staging. Retrieved October 1, 2010, from http://www.cancer.gov/cancertopics/wyntk/myeloma/page6

Shinohara, E. (2008). Multiple myeloma: The basics. Retrieved October 1, 2010, from http://www.oncolink.org/types/article.cfm?c=13&s=42&ss=836&id=9552&p=3

The Cleveland Clinic. (2010). Multiple myeloma and other plasma cell neoplasms. Retrieved October 1, 2010 from http://my.clevelandclinic.org/disorders/Multiple_Myeloma/hic_Multiple_Myeloma _and_Other_Plasma_Cell_Neoplasms_Treatment.aspx