Multiple myeloma stages

To determine which multiple myeloma treatments meet your needs, your care team will learn the stage of the disease, the rate at which the cancer is growing and whether you have kidney problems or other serious symptoms may also influence treatment choices.

Most cancers are staged based on the size and spread of tumors. To stage multiple myeloma, we examine blood cell counts, the amount of protein found in the blood and urine, the calcium level in the blood, and other diagnostic test results.

Multiple myeloma is staged in two ways, both of which divide myeloma into three stages indicated by the Roman numerals I-III. These two multiple myeloma staging systems differ in the factors that are evaluated:

• The Durie-Salmon System considers the levels of monoclonal immunoglobulin, calcium and hemoglobin in the blood, as well as the number of bone lesions (indicating the severity of bone damage). This multiple myeloma staging system is becoming less common.
• The International Staging System for multiple myeloma relies on two main factors to stage multiple myeloma: the levels of albumin and beta-2 microglobulin in the blood.

Multiple myeloma stages are determined in the following ways:

Stage 0: Smoldering myeloma (also called asymptomatic myeloma), a slow-growing type of multiple myeloma, is characterized by increased plasma cells in the bone marrow and the presence of monoclonal proteins, without the presence of symptoms. Smoldering myeloma typically uses a "watch and wait" approach, which holds off on treatment until the disease progresses, with close monitoring of diagnostic tests.

Stage I (stage 1 multiple myeloma): Tests indicate there are a relatively small number of myeloma cells. The levels of beta-2 microglobulin may be slightly higher than normal and the levels of albumin (a water soluble protein) may have decreased.

Stage II (stage 2 multiple myeloma): This is an intermediate stage assigned if the levels tested fall between the standards set for stage I and stage III.

Stage III (stage 3 multiple myeloma): In this stage, the number of myeloma cells is considered high. The most advanced of the stages of multiple myeloma is characterized by high levels of beta-2 microglobulin and low levels of albumin.

Next topic: How is multiple myeloma diagnosed?