What are the Stages of Multiple Myeloma?

Staging in multiple myeloma is not the same as in other cancerous solid tumors. Staging in solid tumors typically indicates the size of the tumor and if that tumor has metastasized or not. Because multiple myeloma is a blood cancer and is intrinsically "metastatic," because it is found throughout the blood and bone marrow, it is staged in a different way. Staging in myeloma is not as helpful as in other cancers, so while there is a consensus on staging, it does not necessarily predict patient outcomes. Keep that in mind as you review your initially diagnosed "stage."

What is the Revised International Staging System (R-ISS) for Multiple Myeloma?

The revised International Staging System was based on a large sample size of 4,445 newly diagnosed multiple myeloma patients from 11 different clinical trials and was updated in 2015. Myeloma experts already knew that high levels of Beta 2 microglobulin and low albumin levels were indicators of higher risk myeloma. The update occurred as myeloma researchers learned more about high risk genetic features and high levels of LDH, which have now been added to the staging system.

R-ISS Stage I

Criteria	Test Type	Results
Beta 2 microglobulin	Blood	Less than 3.5 mg/L
Albumin	Blood	Greater than 3.5 g/dL
Genetics	Bone marrow biopsy	Standard-risk chromosomal abnormalities by FISH
LDH	Blood	At or under normal LDH levels

ISS Stage II (Neither Stage I or Stage III)

Criteria	Test Type	Results
Beta 2 microglobulin	Blood	Between 3.5 - 5.5 mg/L OR
Albumin	Blood	Less than 3.5 g/dL

ISS Stage III

Criteria	Test Type	Results
Beta 2 microglobulin	Blood	Over 5.5 mg/L
Albumin	Blood	Greater than 3.5 g/dL
Genetics	Bone marrow biopsy	High risk chromosomal abnormalities including del 17p, translocation 4;14 or translocation 14;16 by FISH OR
LDH	Blood	LDH over normal levels

Learn more as Dr. Muzaffar Quazilbash of the MD Anderson Cancer Center explains myeloma staging in HealthTree University.

To learn more about the revised International Staging System, click here.