Multiple Myeloma Stages

After someone is diagnosed with multiple myeloma, doctors will try to figure out how advanced it is. This process is called staging. The stage helps doctors describe how much cancer is in the body. It helps determine how serious the myeloma is and how best to treat it. Doctors also use the stage when talking about survival statistics.

The Revised International Staging System

Multiple myeloma is staged using the Revised International Staging System (RISS), which is based on 4 factors:

• The amount of albumin in the blood
• The amount of beta-2-microglobulin in the blood
• The amount of LDH in the blood
• The specific gene abnormalities (cytogenetics) of the cancer

RISS Stage Group	Factors
I	Serum beta-2 microglobulin is less than 3.5 (mg/L) AND Albumin level is 3.5 (g/dL) or greater AND Cytogenetics are considered “not high risk” * AND LDH levels are normal
II	Not stage I or III
III	Serum beta-2 microglobulin is 5.5 (mg/L) or greater AND Cytogenetics are considered “high-risk”* AND/OR LDH levels are high

*Samples from a bone marrow biopsy are typically tested to look at the chromosomes in the cancer cells. This may be done with tests such as cytogenetics or fluorescence in situ hybridization (FISH). Certain chromosome changes can mean a higher risk of a worse outcome. These include:

• Loss (deletion) of a piece of chromosome 17
• An exchange (translocation) of material from chromosomes 4 and 14
• A translocation involving chromosomes 14 and 16

These 3 specific chromosome changes are considered high risk. Most other chromosome abnormalities are considered standard risk or not high risk.

Cancer staging can be complex, so ask your doctor to explain it to you in a way you understand.

Factors other than stage that can affect survival

Other factors can also be important in helping to determine a person's prognosis (outlook), although it's important to keep in mind that each person is different.

Kidney function

The blood creatinine level shows how healthy the kidneys are. The kidneys remove this chemical from the blood. When they are damaged by the monoclonal immunoglobulin, blood creatinine levels rise. This tends to be linked with a worse outlook.

Age

Age can also be important. In the studies of the International Staging System, younger people with myeloma tend to live longer.

Overall health

A person's overall health might also affect their outlook. For example, people with other poorly controlled health conditions, such as diabetes or heart disease, tend not to do as well.