The stages of myeloma

The stage of a cancer tells your doctor how far it has grown or spread. The tests and scans you have when diagnosing your myeloma give some information about the stage. This information helps your specialist plan the treatment that is most appropriate for you.

There are currently 2 staging systems doctors use for myeloma

• The International Staging System
• The Durie-Salmon staging system

The International Staging System

This is the system that has now replaced the older Durie-Salmon system. In 2003 a group of specialists from around the world proposed a system which uses tests that may help to indicate your prognosis. This is called the International Staging System (ISS) and looks at the results of 2 blood tests as part of staging. These blood tests are ß2-microglobulin (ß2-M) and albumin. The ISS has 3 stages 

• Stage 1 - The level of the protein called beta 2 microglobulin (ß2-microglobulin or ß2-M) is less than 3.5 mg per litre.  And the level of albumin in the blood is more than 3.5 grams per decilitre.
• Stage 2 - The levels of beta 2 microglobulin and albumin fall between those in stages 1 and 3.
• Stage 3 - The level of the protein beta 2 microglobulin is more than 5.5 mg per litre.

Doctors now use this system to help them predict how you might respond to treatment.

The Durie-Salmon staging system

This system has been used for many years but is now rarely used. There are 3 stages in this system

Stage 1
This is if you have

• No anaemia (in other words, a normal red blood cell count)
• A normal level of blood calcium
• No bone damage, or a solitary plasmacytoma
• Low levels of abnormal antibodies (immunoglobulin) in your blood or urine

Stage 1 is then divided into A and B. A is for people whose kidneys are working normally. Group B is for people who have some kidney damage. This is measured by a blood test for a chemical called creatinine.

Stage 2
Stage 2 includes anyone who does not fit exactly into stage 1 or stage 3. So, you would be stage 2 if you had 2 areas of bone damage. You can also have stage 2A or 2B. As with stage 1, this depends on whether your kidneys have been damaged at all by the myeloma.

Stage 3
This is if you have

• Anaemia (low red cell count)
• High levels of calcium in your blood
• More than 3 sites of bone damage
• High levels of abnormal paraproteins in your blood or urine

Stage 3 is also divided into stages 3A and 3B, with those in 3B having a high creatinine level in their blood, indicating that they have some kidney damage from their myeloma.

Doctors have recently simplified the way they classify myeloma to help them know which myeloma treatment you need. To do this they look at whether your myeloma is affecting your body tissue and organs and causing symptoms. The symptoms they check for are

• Bone damage
• High blood calcium levels
• Kidney problems
• Low levels of red blood cells (anaemia)
• Repeated infections
• Thickening of your blood because of large amounts of paraprotein (hyperviscosity)

Doctors are then able to group you as having either

• Asymptomatic myeloma
• Symptomatic myeloma

Asymptomatic myeloma

Asymptomatic, smouldering or indolent myeloma means you have

• A higher level of abnormal paraprotein in your blood (more than 30 g/l)
• A higher level of abnormal plasma cells in your bone marrow (more than 10%)
• No related organ or tissue impairment

If your myeloma isn't causing symptoms you usually don't begin treatment. But your doctor will want to monitor you at least every 3 months for any symptoms, in which case you will need treatment.

Symptomatic myeloma

If you have symptomatic myeloma you need to have treatment. Symptomatic myeloma means you have

• Any level of abnormal paraprotein in your blood or urine
• Abnormal plasma cells in your bone marrow, or plasmacytoma
• Damage to tissues or organs (such as bone problems, kidney problems or anaemia as outlined above)

Myeloma can respond very well to treatment and go into remission. This means that there is no sign of active disease in your body. Or the protein can remain at the same level (plateau). But it nearly always comes back or rises again in time. It is then called relapsed myeloma or recurrent myeloma.