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Multiple Myeloma Stages

After someone is diagnosed with cancer, doctors will try to figure out if it has spread, and if so, how far. This process is called staging. The stage of a cancer describes how much cancer is in the body. It helps determine how serious the cancer is and how best to treat it. Doctors also use a cancer's stage when talking about survival statistics.

The Revised International Staging System

Multiple myeloma is staged using the Revised International Staging System (RISS) 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



Serum beta-2 microglobulin is less than 3.5 (mg/L)


Albumin level is 3.5 (g/dL) or greater


Cytogenetics are considered “not high risk” *


LDH levels are normal



Not stage I or III


Serum beta-2 microglobulin is 5.5 (mg/L) or greater


Cytogenetics are considered “high-risk”*


LDH levels are high

*The bone marrow may be sent for tests to look at the chromosomes in the cancer cells. This test may also be called cytogenetics. Certain chromosome changes can mean a poorer outlook. For example, loss of a piece of chromosome 17 is linked to a poorer outcome. Another genetic abnormality that predicts a poor outcome is an exchange of material from chromosomes 4 and 14. This is called a translocation. A translocation involving chromosomes 14 and 16 is also linked to a poorer outcome. These 3 specific chromosome changes are considered high risk. 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 affect survival

    Kidney function

    The blood creatinine level shows how healthy the kidneys are. Kidneys eliminate this chemical from the body. When they are damaged by the monoclonal immunoglobulin, blood creatinine levels rise, predicting a worse outlook.


    Age is also important. In the studies of the international staging system, older people with myeloma do not live as long.

    Overall Health

    Overall health can affect the outlook of someone with myeloma. Poorly controlled health conditions, such as diabetes or heart disease, for example, can predict a worse prognosis.

    The American Cancer Society medical and editorial content team

    Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as editors and translators with extensive experience in medical writing.

    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.

    Greipp PR, San Miguel J, Durie BG, et al. International staging system for multiple myeloma. J Clin Oncol. 2005;23(15):3412-3420.

    Last Revised: February 28, 2018

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