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. Staging helps your care team consider treatment options and your prognosis, or chance of recovery.

Multiple myeloma is staged in two ways, both of which divide myeloma into three stages indicated by the numbers 1-3. 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.

How multiple myeloma stage is determined

Once a monoclonal gammopathy is defined as a cancerous multiple myeloma, doctors sort it into one of three stages, but they’ll need some more information first.

Test results help determine the cancer’s stage: A few important proteins that your care team tests for when determining multiple myeloma staging are beta-2 microglobulin, albumin and lactate dehydrogenase. These, along with analysis of the cancer’s chromosomes, help your doctor pinpoint what stage the cancer is at:

• Beta-2 microglobulin is a protein normally found in plasma cells that the myeloma cells start making and releasing in your blood in unusually high concentrations.
• Albumin is a protein in your blood that normally makes up a significant portion of the clear liquid called plasma surrounding your blood cells. As multiple myeloma worsens, levels of albumin in the blood drop.
• Lactate dehydrogenase is a protein involved in cellular energy production in your body’s tissues. As these tissues are damaged by the advancing cancer, they start releasing lactate dehydrogenase into the blood. So higher levels of lactate dehydrogenase indicate later stage or more advanced multiple myeloma.
• Cytogenetics is the analysis of the chromosomes of the cancerous cell to see if they look normal or if they’ve undergone a process that has changed their structure, an indicator that the cancer has advanced. Doctors will use the myeloma cell’s cytogenetics as another clue to determine the cancer’s stage.

Along with these test results, your care team will look at how many tumors there are, how much bone marrow is affected, and how much the cancer has decreased the levels of your red blood cells, white blood cells and platelets.

Multiple myeloma stages

Once your doctor has your test results and protein levels, he or she can sort the cancer into one of three stages:

Stage 0 (smoldering or asymptomatic multiple myeloma) characteristics:

• Serum monoclonal protein (immunoglobulin A or immunoglobulin G) greater than or equal to 30 g/L or urinary monoclonal protein greater than or equal to 500 mg per 24 hours and/or clonal bone marrow plasma cells 10-60 percent
• Blood counts, calcium levels and kidney function are normal
• Unnoticeable or no damage to bones or organs
• No evidence of amyloid protein buildup (amyloidosis)

Stage 1 characteristics:

• Beta-2 microglobulin is lower than 3.5 mg/L
• Albumin is 3.5 g/dL or higher
• Cytogenetic studies don’t point to high-risk cell changes
• Lactate dehydrogenase levels are normal

Stage 2 characteristics:

• All multiple myelomas that don’t fall into stage 1 or stage 3 are considered stage 2.
• Beta-2 microglobulin is between 3.5mg/L and 5.5 mg/L
• Cytogenetics don’t show high risk or can’t be determined

Stage 3 characteristics:

• Beta-2 microglobulin is 5.5 mg/L or higher
• Cytogenetics show chromosomal changes in the myeloma cells that are high risk and/or lactate dehydrogenase levels are high

Cancer’s stage affects survival and prognosis

The cancer’s stage plays a big role in your prognosis, or your chance of recovery. According to the National Cancer Institute SEER Program, the average five-year relative survival rate for multiple myeloma between 2010 and 2016 was about 54 percent—meaning about 54 percent of the people diagnosed with multiple myeloma at any stage are alive five years after their diagnosis.

That survival rate changes a bit based on how far the cancer has spread. This is classified in two ways for multiple myeloma:

• Localized—only one tumor is growing inside or outside the bone, what we defined above as a plasmacytoma. The five-year survival rate for localized multiple myeloma (one plasmacytoma) is about 75 percent.
• Distant—multiple tumors are found inside or outside the bones, a classic multiple myeloma. The five-year survival rate for distant multiple myeloma is lower—about 53 percent.

Unfortunately, 95 percent of multiple myeloma cases are diagnosed at the distant stage, after it has metastasized.

There’s at least some good news on the horizon—the five-year survival rate has been improving, from around 35 percent in 2000 to 56.5 percent in 2012. Hopefully, these survival rates continue to improve with new therapies and treatment approaches. Your care team will continue to monitor you after treatment so they can ensure that your multiple myeloma hasn't relapsed.