To find out what stage the myeloma is, doctors use a staging system. The International Staging System (ISS) looks at the results of 2 blood tests:
- beta-2 microglobulin (B2M)
- albumin level.
If the level of B2M is raised or if the level of albumin is lower than normal, these can be signs that the myeloma is more advanced.
With this staging system, there are 3 stages of myeloma. Stage 1 is the earliest stage and stage 3 is more advanced (see the table below).
The stage of the myeloma does not usually affect the treatment that is offered. So, doctors do not always talk about staging.
|Stage||B2M (measured in mg/L)||Albumin (measured in g/dL)|
|Stage 1||Normal or near normal (less than 3.5)||Normal (3.5 or more)|
|Normal or near normal (less than 3.5)||Low (less than 3.5)|
|Raised (3.5 to 5.5)||Any level|
|Stage 3||High (5.5 or more)||Any level|
Revised International Staging System (R-ISS) for myeloma
Sometimes doctors use an adapted version of the ISS called the Revised International Staging System (R-ISS). This uses:
- the results of the blood tests from the ISS
- a blood test called lactate dehydrogenase (LDH)
- the results of the FISH test, if you have had one that looked for any genetic changes in the myeloma cells.
Doctors look at the effect the myeloma is having on your body. They may look at test results using something called the CRAB criteria to assess this. CRAB stands for:
- C – calcium levels are raised.
- R – renal (kidney) problems.
- A – anaemia (low number of red blood cells).
- B – bone damage.
The doctors also ask whether you have been having repeated infections or symptoms related to thickening of the blood (hyperviscosity). These may include confusion, headaches or blurred vision.
We have more information about managing myeloma symptoms.
Below is a sample of the sources used in our myeloma information. If you would like more information about the sources we use, please contact us at email@example.com
National Institute for Health and Care Excellence (NICE). Myeloma: diagnosis and management. NICE guideline [NG35]. Published: 10 February 2016 Last updated: 25 October 2018. Available from: https://www.nice.org.uk/guidance/ng35/chapter/recommendations Accessed: 19/07/22
Jonathan Sive et al., on behalf of the British Society of Haematology. British Journal of Haematology. Guidelines on the diagnosis, investigation and initial treatment of myeloma: a British Society for Haematology/UK Myeloma Forum Guideline. Published: 21 March 2021 Available from: https://onlinelibrary.wiley.com/doi/10.1111/bjh.17410 Accessed: 19/07/22
M.A. Dimopoulos et al. Annals of oncology. European Society for Medical Oncology (ESMO). Multiple myeloma: EHA-ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Volume 32, ISSUE 3, P309-322, March 01, 2021. Available from: https://www.annalsofoncology.org/article/S0923-7534(20)43169-2/fulltext Accessed: 19/07/22
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