[Music] how do I know the stage of my myeloma of course once we establish the diagnosis of any cancer the next task is to determine the extent of the disease what's the disease burden and the best way to determine that in a reproducible ways to determine the stage of the disease and for that of course myeloma specialist and international myeloma working group has come up with this international staging system now a quick note about why myeloma is staged the way it is in cancers of solid tumors like breast cancer you stage by the size of the tumor but in myeloma it's all over the body so you can't stage that way myeloma is a complicated disease this is why it is proven difficult to come up with a staging system that applies to all my little patients as dr. calabash will explain the original myeloma staging took into account albumin and beta 2 microglobulin the newest version of myeloma staging the revised ISS takes into account another blood marker LDH and the high-risk genetics of your disease the more we learn about myeloma the more staging of the disease may continue to evolve over time so the original international staging system which was again based on a lot of data from clinical trials and observation showed that two factors beta 2 microglobulin and serum albumin determined the stage of the disease that high beta 2 microglobulin or low albumin basically determined the stage of the disease high beta 2 microglobulin bad low albumin patients at ISS stage one when they had beta 2 microglobulin level of less than 3.5 or serum albumin of 3.5 or higher which was normal or ISS stage 3 where they had a very high beta 2 microglobulin of more than 5.5 and in between was ISS stage 2 but then away and others learned that there are additional factors like LDH level of protein that we all have in our blood but it can go up in certain cancers including multiple myeloma so people started taking into consideration LDH level another important factor is cytogenetics those chromosomal abnormalities so the revised ISS staging system international staging system took into consideration took into account not just beta 2 microglobulin and albumin but also chromosomal abnormalities and fish studies as well as LDH level so in very simple terms in revised ISS stage one is what was the old ISS stage one was that is low beta 2 microglobulin and normal to high albumin but with that these patients should also have normal LDH and they should not have any high-risk chromosomal abnormalities and there are three of those that are incorporated in the revised ISS staging system deletion 17p which we all know is a high-risk abnormality translocation 414 and translocation 1460 so patients should not have either of these three and should have normal ld8 in addition to the old ISS stage 1 on the other hand ISS stage 3 patients would have what a revised ISS stage 3 patients would have the old ISS stage 3 plus either a high LDH level and then each institution has its own upper limit of normal and if it is above that to limit it is high LDH and that would put patient in revised ISS stage 3 and or patients have one of those three chromosomal abnormalities on fish studies that I outlined deletion 17p translocation 414 or translocation 414 16 and then of course those who do not fall either and revised diocese stage 1 or revised ISS stage 3 are revised ISS stage