Staging is the process of finding out how widespread or advanced the cancer is. This is very important because treatment options and the outlook for recovery depend on the stage of the cancer. Knowing all you can about staging helps you make the best choice about your treatment.

Staging systems used for multiple myeloma

The International Staging System

Recently, a new staging system called the International Staging System for Multiple Myeloma has been developed. It divides cases of myeloma into 3 stages based only on the serum beta-2 microglobulin and serum albumin levels. Other factors that may be important are kidney function, platelet count, and the patient's age.

The Durie-Salmon staging system

Multiple myeloma may be staged using the Durie-Salmon system. Although some doctors use this system, its value is becoming limited because of newer diagnostic methods. This system is based on 4 factors:

The amount of abnormal antibodies or proteins in the blood or urine: Large amounts show that there are many cancerous plasma cells.

The amount of calcium in the blood: High blood calcium levels are linked to advanced bone damage. Because bone contains lots of calcium, bone damage releases calcium into the blood.

The degree of bone damage based on x-rays: Many areas of bone damage seen on x-rays point to an advanced stage of the cancer.

The amount of hemoglobin in the blood: Hemoglobin is the part of red blood cells that carries oxygen. Low hemoglobin levels mean that the myeloma cells fill a lot of the bone marrow. Not enough space is left for the marrow cells that make red blood cells.

This system uses these factors to divide myeloma into 3 stages. Stage I is the smallest amount of tumor, and stage III the largest.

Other ways to describe multiple myeloma

Smoldering myeloma and indolent myeloma: These terms refer to early myeloma that does not seem to be growing and is not causing any symptoms. People with smoldering myeloma have normal blood counts, normal calcium levels, normal kidney function, and no bone or organ damage. These patients are often watched very carefully without treatment.

Recurrent multiple myeloma: Recurrent disease means that the cancer has come back (recurred) after treatment. Multiple myeloma can return in the bone or in another part of the body.

Other factors used to predict outlook

Kidney function: Creatinine is removed from the body by the kidneys. The blood creatinine level reflects the kidney's health. The levels go up when the kidneys are damaged. High blood creatinine levels mean the patient's outlook is not as good.

Age: Age is also important. Older people with myeloma do not live as long.

Myeloma cell labeling index: This tells how fast the cancer cells are growing. This test is done in special labs, using myeloma cells from bone marrow samples. A high labeling index predicts faster growth of cancer cells and a worse outlook.

Chromosome studies: The bone marrow may be sent for tests to look at the chromosomes in the cancer cells. Certain chromosome changes can point to a worse outlook.

Other tests: Tests may be done to check the patient's overall health and the condition of the heart or other organs that could be affected by some of the drugs used to treat this disease.

Last Medical Review: 03/13/2009
Last Revised: 05/06/2009