Multiple myeloma stages

To determine which multiple myeloma treatment options meet each patient's needs, the care team identifies which of the multiple myeloma stages aligns with the patient's diagnosis, the rate at which the cancer is growing and whether the patient has kidney problems or other serious symptoms that may also influence treatment choices.

Most cancers are staged based on the size and spread of tumors. To stage multiple myeloma, the care team examines 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 the care team consider treatment options and the patient's 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 stages are determined

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

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

Beta-2 microglobulin is a protein normally found in plasma cells that the myeloma cells start making and releasing in the blood in unusually high concentrations.

Albumin is a protein in the blood that normally makes up a significant portion of the clear liquid called plasma surrounding the blood cells. As multiple myeloma worsens, levels of albumin in the blood drop.

Lactate dehydrogenase is a protein involved in cellular energy production in the body’s tissues. As these tissues are damaged by the advancing cancer, they start releasing lactate dehydrogenase into the blood. 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 use the myeloma cell’s cytogenetics as another clue to determine the cancer’s stage.

Along with these test results, the patient's care team examines how many tumors exist, how much bone marrow is affected, and how much the cancer has decreased the levels of the patient's red blood cells, white blood cells and platelets.

Stages of multiple myeloma

Once the patient's care team has the test results and protein levels, he or she can sort the cancer into one of three stages.

Stage 0 multiple myeloma

Stage 0 (asymptomatic or smoldering 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 multiple myeloma

Stage 1 myeloma 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 multiple myeloma

Stage 2 myeloma 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 multiple myeloma

Stage 3 myeloma 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

Is there a stage 4 multiple myeloma?

There is no stage 4 myeloma. The stages of this disease range from 0 to 3.

Multiple myeloma survival rate

One way to estimate life expectancy when battling cancer is to consider the five-year relative survival rate for that type of cancer. A five-year relative survival rate shows the likelihood that a person with a specific type and stage of cancer may live for at least five years after the diagnosis, compared with people who don't have cancer. The rate includes the life expectancy of patients who are still in treatment and those who have finished treatment and have no further evidence of disease.

According to the National Cancer Institute SEER (Surveillance, Epidemiology and End Rules) Program, the average five-year relative survival rate for multiple myeloma between 2013 and 2019 was about 60 percent.

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

Localized: Only one tumor is growing inside or outside the bone, defined above as a plasmacytoma. The five-year survival rate for localized multiple myeloma (one plasmacytoma) is about 79.5 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 59 percent.

Unfortunately, 96 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 62 percent in 2015. The hope is that these survival rates continue to improve with new therapies and treatment approaches. The patient's care team will continue to monitor him or her after treatment so they can ensure that the multiple myeloma hasn't relapsed.