By relying on a process called staging, doctors can determine how advanced multiple myeloma is. Find out more about the stages of multiple myeloma and how health professionals categorize multiple myeloma remission.
When doctors stage your disease, they can develop a treatment plan for your condition. They will also measure how you respond to treatment, allowing for accurate monitoring of your condition and better treatment decision-making.
Multiple Myeloma Stages
After a patient receives a myeloma diagnosis, doctors will try to determine how advanced the disease is. This is called staging. Staging your disease helps doctors determine the seriousness of your condition and how best to treat it. While staging offers crucial information about a patient's condition, various factors, including your age, overall health, and kidney function, can also affect a person's diagnosis.
How to Determine the Stages of Multiple Myeloma
Your doctor may refer to your myeloma by “stage”, represented by the Roman numeral I, II, or III. The Revised International Staging System (R-ISS) uses the following blood tests to define what stage your myeloma is when you are diagnosed:
- Beta-2 Microglobulin (B2M) is a tumor marker in myeloma. Higher levels indicate a higher myeloma burden.
- Lactate dehydrogenase (LDH) is a measure of tissue damage. Higher levels indicate more tissue damage and myeloma burden.
- Albumin (Alb) is a healthy protein that can be lower when myeloma is active. Lower levels can indicate a higher myeloma burden.
Additionally, the R-ISS incorporates genetic changes (chromosomal abnormalities) found in bone marrow myeloma cells. This combined information gives the stage of myeloma, has some prognostic value, and can help guide treatment.
| R-ISS Stage | Markers |
|---|---|
| Stage I | Serum Alb ≥ 3.5 g/dL, Serum B2M <3.5 mg/L, Normal LDH, Standard-risk chromosomal abnormalities |
| Stage II | Not fitting criteria for Stage I or III |
| Stage III |
Serum B2M ≥ 5.5 mg/L, High-risk chromosomal abnormalities and/or high LDH
|
This chart depicts the Multiple Myeloma stages and their markers.
What Is Active Myeloma?
In most cases, active multiple myeloma is the least complicated biologically and is easiest to treat early in the disease course. The amount of monoclonal protein (M-protein) secreted by myeloma cells is lowest when the disease is still asymptomatic, in the MGUS and smoldering myeloma phase.
As the disease progresses, the myeloma cells grow in number, resulting in higher levels of monoclonal protein. When biomarkers show that multiple myeloma is either already symptomatic or will soon become symptomatic, treatment is initiated.
What Are First-Line Treatments in Myeloma?
The first line of treatment is called "induction" or "frontline" therapy. In killing myeloma cells, therapy reduces the amount of monoclonal protein and halts further medical problems related to multiple myeloma. Current frontline combination therapy usually produces a deep and durable response or "remission," during which time the production of monoclonal protein levels off or "plateaus."
What Are the Types of Remission in Myeloma?
After finishing treatment, your doctor will assess how well your body responded to it.
Remissions are categorized as follows:
- Stable disease (SD) means that the amount of monoclonal protein neither increased nor decreased.
- Minimal response (MR) indicates a drop in monoclonal protein of at least 25%.
- A partial response (PR) indicates a decrease of 50% in monoclonal protein.
- A very good partial response (VGPR) indicates that monoclonal protein has been reduced by 90%.
- In a complete response (CR), tests cannot detect any monoclonal protein.
Remissions are often maintained for long periods of time with continuous or "maintenance" therapy. But because myeloma is a remitting and relapsing disease, in most cases, the myeloma cells that have resisted prior treatment will begin to grow again in time, monoclonal protein levels will increase again, and a relapse will occur.
How Do You Monitor Your Myeloma on an Ongoing Basis?
Your doctor will order various tests and monitor your results closely in order to treat you at the appropriate time — not too soon, but before you experience medical problems related to your multiple myeloma. Treatment starts with a new regimen or with one that worked well for you during induction therapy. In most, but not all, cases, the response to treatment for this first relapse is shorter than the response to frontline therapy.
There are many treatment options for successive relapses. Most patients do well for long periods of time — many live for decades after diagnosis — but in most cases, responses become shorter and less deep with each subsequent relapse, and the disease eventually becomes refractory — unresponsive — to available treatments.
Learn More About Multiple Myeloma
For more information about myeloma disease progression and related topics, visit our online resource library for free, downloadable resources. You can also direct your questions to one of our experts when you phone our InfoLine. Our compassionate coordinators can chat with you at a time that works for you.
The Durie-Salmon Staging System demonstrates the correlation between the amount of myeloma and the damage it has caused, such as bone disease or anemia.
The International Myeloma Foundation medical and editorial content team
Comprised of leading medical researchers, hematologists, oncologists, oncology-certified nurses, medical editors, and medical journalists, our team has extensive knowledge of the multiple myeloma treatment and care landscape.
Additionally, the content on this page is medically reviewed by myeloma physicians and healthcare professionals.
Last Medical Content Review: July 20, 2021