Doctors stage multiple myeloma using either the Durie-Salmon Staging System or the Revised International Staging System (RISS). Multiple myeloma stages range from 0 to 3, with 3 being the most advanced.
Multiple myeloma is a blood cancer that forms in the white blood cells produced by bone marrow. Doctors stage multiple myeloma based on the levels of proteins produced by cancerous cells found throughout the body and other clinical factors affected by cancer.
A higher stage means that the cancer has progressed and spread (metastasized). Typically, a higher stage, like stage 3, also causes more symptoms and requires more aggressive treatment.
Multiple myeloma is a type of blood cancer that forms in plasma cells. Plasma cells are a type of white blood cell. Healthy plasma cells are an important part of the immune system and help the body fight infections.
When multiple myeloma develops, cancerous plasma cells form. These plasma cells don’t help your body fight infection. Over time, these cells multiply and overwhelm your healthy plasma cells.
Tests such as bloodwork can help detect multiple myeloma. Blood tests can show the presence of proteins made by cancerous plasma cells.
If your doctor suspects multiple myeloma, you might also be asked to do a bone marrow biopsy since plasma cells are produced in your bone marrow.
Sometimes, imaging tests such as X-rays or MRIs are done to look for bone damage and other signs of multiple myeloma.
Multiple myeloma is staged using the Durie-Salmon Staging System or the Revised International Staging System (RISS).
The Durie-Salmon Stage System assigns stages by looking at:
- level of kidney function
- level of blood calcium
- hemoglobin concentration
- amount of M protein in blood and urine
- presence of bone lesions in imaging studies
Durie-Salmon Stage System stages of multiple myeloma
| Stage | Criteria |
|---|---|
| I | • hemoglobin level > 10 g/dL • serum calcium level < 10.5 mg/dL • a normal bone structure or solitary bone plasmacytoma assessed with conventional radiography • low rate of M-component production (IgG level < 5 g/dL; IgA level < 3 g/dL • Bence Jones protein level < 4 g/24 h |
| II | Neither stage I nor stage III |
| III | One or more of the following: • hemoglobin value < 8.5 mg/dL • serum calcium level > 12.5 mg/dL • advanced lytic bone lesions assessed with conventional radiography • high M-component production rate (IgG value > 7g/dL; IgA value > 5 g/dL; Bence Jones protein > 12 g/24 h) |
The RISS
- amount of albumin in blood
- amount of LDH in blood
- amount of beta-2 microglobulin in blood
- gene abnormalities of multiple myeloma
Below we break down the RISS stages for multiple myeloma and their treatments:
Stage 0 is sometimes called smoldering multiple myeloma or asymptomatic multiple myeloma. At this stage, there are often no symptoms.
Clinical criteria for Stage 0 include:
- blood counts, calcium levels, and kidney function are all normal
- no bone or organ damage
- no evidence of amyloid protein buildup
- serum monoclonal protein greater than or equal to 30 g/L, urinary monoclonal protein greater than or equal to 500 mg per 24 hours, or clonal bone marrow plasma cells 10–60%
Stage 0 multiple myeloma treatment
Treatment isn’t typically needed at this stage. Instead, careful monitoring and regular testing are used to watch for progression.
Multiple myeloma needs to meet certain criteria. This includes:
- albumin levels greater or equal to 3.5 g/dL
- serum beta-2 microglobulin less than 3.5 mg/L
- cytogenetics that are not classed “high risk”
- normal LDH levels
You might notice symptoms such as bone pain and weakness in your arms and legs at this stage.
Stage 1 multiple myeloma treatment
Drug therapies are the primary treatment for multiple myeloma. These therapies aim at destroying multiple myeloma cells and include options such as:
- proteasome inhibitors
- chemotherapy
- steroids
- antibodies
- immunomodulatory drugs (IMiDs)
- b-cell maturation antigen (BCMA)-targeted therapies
A treatment plan for stage 1 multiple myeloma might include one or a combination of these drug therapies. You might also have treatments such as radiation therapy or a stem cell transplant, depending on your individual treatment plan.
Stage 2 multiple myeloma needs to meet certain criteria. This includes:
- beta-2 microglobulin between 3.5 mg/L and 5.5 mg/L
- cytogenetics are either not high risk or have a risk level that is undefined
- it’s not stage 1 or stage 3
By stage 2, symptoms might be more advanced, including loss of appetite or stomach pain.
Stage 2 multiple myeloma treatment
Treatment options in stage 2 are the same as the treatment options in stage 1. Drug therapies can be used alone or in combination with options such as radiation therapy or a stem cell transplant.
In stage 2, higher doses or more potent drugs might be used.
Stage 3 is the most advanced stage of multiple myeloma. To be classed stage 3, multiple myeloma needs to meet these criteria:
- cytogenetics are considered high risk
- serum beta-2 microglobulin equal or greater to 5.5 mg/L
- high levels of LDH
You might also have advanced symptoms at this stage. These could include severe bone pain and kidney failure.
Stage 3 multiple myeloma treatment
Treatment by stage 3 is more aggressive to slow and stop the cancer from spreading further. Additional treatments with drug therapies are typically still part of treatment plans.
A stem cell transplant might also be an option. You and your team can discuss if this is an option for you.
RISS stages for multiple myeloma
| Stage | Criteria |
|---|---|
| I | • albumin level greater or equal to 3.5 g/dL • serum beta-2 microglobulin less than 3.5 mg/L • cytogenetics not classed high risk • normal LDH levels |
| II | • not stage 1 or stage 3 • beta-2 microglobulin between 3.5 mg/L and 5.5 mg/L • cytogenetics are either not high risk or have a risk level that is undefined |
| III | • cytogenetics considered high risk • serum beta-2 microglobulin equal or greater to 5.5 mg/L • high levels of LDH |
Multiple myeloma is a blood cancer that affects plasma cells. Doctors use certain staging systems to discuss how far multiple myeloma has spread.
As multiple myeloma advances, stages increase from 1 to 3. Often, later stages require more aggressive treatment.
Treatment for multiple myeloma includes several different drug therapies, radiation therapy, and stem cell transplants, as well as any treatments needed to address symptoms and complications.