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Multiple Myeloma Stages
If you are diagnosed with multiple myeloma, doctors will try to figure out how advanced it is. This process is called staging. Staging for multiple myeloma is based largely on the results of tests that have been done.
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 (R-ISS), which is based on 4 factors:
- The amount of beta-2-microglobulin (B2M) in the blood
- The amount of albumin in the blood
- The amount of lactate dehydrogenase (LDH) in the blood
- The specific gene abnormalities (cytogenetics) in the cancer cells
RISS Stage Group |
Factors |
I |
B2M 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 |
B2M 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. Other chromosome abnormalities are considered standard risk or not high risk.
Second Revised International Staging System
A newer revision of the International Staging System, known as R2-ISS, is now being evaluated and may be used in some cancer centers. This system takes into account additional chromosome changes when determining risk, and it divides myeloma into 4 stages instead of 3.
Multiple myeloma staging can be complex, so ask your cancer care team to explain it in a way you understand.
Factors other than stage that can affect survival for multiple myeloma
Other factors can also play a role in determining a person's prognosis (outlook) with multiple myeloma. But 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. 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.
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- References
Developed by the American Cancer Society medical and editorial content team with medical review and contribution by the American Society of Clinical Oncology (ASCO).
American Joint Committee on Cancer. Plasma Cell Myeloma and Plasma Cell Disorders. In: AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer; 2017:973.
Laubach JP. Multiple myeloma: Staging and prognostic studies. UpToDate. 2024. Accessed at https://www.uptodate.com/contents/multiple-myeloma-staging-and-prognostic-studies on January 13, 2025.
Palumbo A, Avet-Loiseau H, Oliva S, et al. Revised International Staging System for multiple myeloma: A report from International Myeloma Working Group. J Clin Oncol. 2015; 33(26):2863-2869.
Last Revised: February 28, 2025
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