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What Are The Stages Of Multiple Myeloma?

Multiple myeloma is one of the common forms of blood cancers. The survival rates depend on the stage of diagnosis. Although there is no cure for multiple myeloma the treatment can help in prolonging the life of individuals. Staging helps in analyzing the spread of disease and its location.

What Are The Stages Of Multiple Myeloma?

Stage of cancer is confirmed by the diagnostic test. The stage of disease determines the prognosis and the possible outcome. There cannot be a generalized stage for all types of cancers. Each cancer has different stages. (1) In multiple myeloma, it is important whether the patient is symptomatic or asymptomatic. The patients who do not produce any symptoms have not advised any treatment. The treatment is aimed at controlling the progression and spread of the disease. Asymptomatic multiple myeloma requires careful monitoring on a regular basis to avoid spread and to control; this is called active surveillance for smoldering myeloma. Patients who show symptoms require treatment. Although there is no cure for the disease it does require treatment. The symptoms of multiple myeloma can be explained with the acronym “CRAB” (2)

Calcium levels- There will be increased calcium levels due to boss loss. The calcium levels are greater than 0.25 mmol/L then the condition is called hypercalcemia. The excess calcium gets deposited in the soft tissues and the kidney.

Renal Problem- There will be increased creatinine levels greater than 173 mmol/L. If left untreated it can result in kidney failure.

Anemia– The bone marrow does not produce enough amounts of red blood cells as the stem cells fail to differentiate into healthy cells. There will be a decreased amount of hemoglobin and oxygen-carrying capacity.

Bone- Patients with multiple myeloma have bone pain, bone lesions, thinning of bones due to osteoporosis and a compression fracture of the spine.

Apart from CRAB symptoms, there will be thickening of blood due to the increased amount of antibodies in the blood, amyloidosis- abnormal amyloid proteins are produced by the bone marrow which gets deposited in the bone and soft tissues. The patients will also suffer from recurrent infections, fever and shortness of breath, weakness, weight loss, nausea and constipation. Patients who show symptoms of CRAB are an indication of an active form of multiple myeloma. People who do not have CRAB features but the diagnostic tests which indicate 60% bone marrow plasma cells, Kappa-to-lambda ratio greater than 100 and bone lesion as diagnosed with MRI or PET-CT imaging. (3)

There are different methods for the classification of stages of multiple myeloma. The international staging system is most commonly used for classification of multiple myeloma. The classification is based on the data collected from people with multiple myeloma across the globe. The classification is based on the levels of serum albumin and the levels of serum β2-M. Here we present you the international staging system

Stage I– The levels of serum β2-M greater than 3.5 mg/L with serum albumin of 3.5 g/dL or more

Stage II– There are two criteria for the classification of Stage II, β2-M between 3.5 mg/L and 5.5 mg/dL and serum Albumin <3.5 g/dL

Stage III– The levels of serum β2-M greater than 5.5 mg/L. There has been an inclusion of serum lactase dehydrogenase (LDH) and high-risk gene abnormalities. It helps in defining the prognosis. A higher blood level of LDH decreased is the response rate to the treatment. Genetic changes in the chromosomes indicate the aggressive form of the disease and also determine the disease progression.

Recurrent Or Relapsed Myeloma– As the name says, the disease is relapsed after complete control and treatment. If there is relapse (also called as recurrence), then cancer needs to be staged again.


Multiple myeloma can be classified based on the serum levels of albumin and serum β2-M as stage I, II and III. The relapsed or recurrent form of the disease needs to be staged again. Genetic factors also determine the aggressiveness of the disease.


Also Read:

Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:September 22, 2021

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