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Staging in 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." 

The Revised International Staging System (R-ISS)

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.

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



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. 

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