Once you have been diagnosed with multiple myeloma, the next step involves determining the stage of the disease. Determining the stage is a way for the doctors to describe the location of tumor cells, if and to what organ they have spread, and whether they are affecting other parts of the body. Also, staging multiple myeloma helps the doctors to devise the best treatment and prognosis for the condition.

Describing myeloma as symptomatic or asymptomatic
Generally, the first step of staging the disease begins with categorizing the cancer as indicative or not.

For this, the doctors look at the results acquired from various diagnostic tests such as blood and urine test, imaging scans, and others.

An acronym CRAB is used to describe the criteria they are looking at:

• C – Calcium evaluation
• R – Renal insufficiency
• A – Anemia
• B – Bone anomalies

In case the condition does not cause any of these symptoms, it is known as smoldering multiple myeloma (SMM).

The revised international staging system (RISS)
Nowadays, multiple myeloma is staged using the RISS approach, i.e. Revised International Staging System. This includes checking:

• The quantity of albumin in the blood: Albumin is a specific kind of protein produced by the liver. This protein plays a very significant role in combating infections and repairing or building muscle tissue.
• The quantity of Beta-2 microglobulin in the blood: This is a special protein produced by the myeloma cells. The presence of this protein in high quantities in the blood is a significant indicator of an advanced stage.
• The quantity of LDH in the blood: This is an enzyme found in the tissues of the body. High quantity of this enzyme in the blood indicates severe tissue damage or disease.
• The specific gene anomalies (Cytogenetics) of the cancer: Certain changes in the chromosomes, for instance, loss of a piece of chromosome 17, increases the risks associated with multiple myeloma.

On the basis of this information, multiple myeloma is classified into 3 stages:

Stage 1

• Beta-2 microglobulin is < 3.5 (mg/L)
• Albumin is 3.5 (g/DL) or more
• LDH levels are normal
• Cytogenetics are considered “not risky”

Stage 2:

• Beta 2-microglobulin is ≥ 3.5 mg/L but < 5.5 mg/L
• Serum albumin < 3.5 g/DL

Stage 3:

• Beta-2 microglobulin is 5.5 (mg/L) or more
• Cytogenetics are considered “risky”
• LDH levels are high

Durie-Salmon Staging System

This is another staging system used by doctors for determining the extent of the disease. It uses stages 1, 2, and 3.

• Stage 1: This indicates that there are only limited myeloma cells in the body. The number of RBCs is within range. The amount of calcium in the body is also normal. However, there are low levels of M protein in the blood and urine.
• Stage 2:  The criteria for Stage 2 can be defined as those that do not fit in either Stage 1 or 3. But it is important to note that more cancer cells are present in the body in Stage 2.
• Stage 3: A lot of myeloma cells are present in the blood. RBC count is low and blood calcium levels surge. There are signs of bone damage with extremely high levels of M protein in the blood and urine.

Doctors devise the best treatment plan based on the stage you are in. Hence, an early diagnosis can help in many ways.