Multiple Myeloma: Stages

March 21, 2017

Multiple Myeloma: Stages

What does stage of cancer mean?

The stage of a cancer is how much and how far the cancer has spread in your body. Your healthcare provider uses exams and tests to determine this. The stage of a cancer is one of the most important things to know when deciding how to treat the cancer.

What are the stages of multiple myeloma?

Different systems have been used to stage multiple myeloma. The most recent system is the Revised International Staging System (R-ISS).

Revised International Staging System

The R-ISS divides multiple myeloma into three stages. These are based mainly on the results of certain lab tests.

Stage I includes myelomas with all of the following:

  • Serum beta-2 microglobulin (B2M) is less than 3.5 mg/dL.

  • Serum albumin is at least 3.5 g/dL.

  • Serum lactate dehydrogenase (LDH) is normal.

  • The myeloma cells do not have any high-risk chromosome abnormalities.

Stage II includes all myelomas that do not fall into stage I or stage III.

Stage III includes myelomas with a serum B2M of at least 5.5 mg/dL, plus at least one of the following:

  • The myeloma cells have high-risk chromosome abnormalities.

  • Serum LDH is higher than normal.

Durie-Salmon system

This older system is based on four factors:

  • The amount of abnormal monoclonal immunoglobulin (M protein) in your blood or urine. Large amounts of are a sign that there are many cancerous (malignant) plasma cells making this abnormal protein.

  • The amount of calcium in your blood. High blood calcium levels are often related to advanced bone damage. Bone destruction releases calcium into the blood.

  • The amount of bone damage seen on X-rays. Many areas of bone damage are a sign of a more advanced stage of multiple myeloma.

  • The amount of hemoglobin in your blood. Hemoglobin is the part of the red blood cell that carries oxygen. Low hemoglobin levels (anemia) are a sign that the myeloma cells are taking up a lot of the bone marrow. There is not enough space left for the normal marrow cells that make red blood cells.

These factors are used to divide multiple myeloma into three stages:

Stage I. X-rays and blood tests show that there are a small number of myeloma cells in your body. Most people with this stage do not have symptoms. Your healthcare provider may say that you have a low tumor burden at this stage.

Stage II. The myeloma cells have spread through the body a little bit. Your healthcare provider may say that you have an intermediate tumor burden at this stage.

Stage III. X-rays and blood tests show that many cancer cells are in your body. Your healthcare provider may say that you have a high tumor burden at this stage.

The Durie-Salmon system is not used as much now as it was in the past. If your healthcare provider uses this system, ask him or her to explain how it applies to you.

Other factors

Along with the stage of a myeloma, other factors can also affect a person's outlook (prognosis). For instance, people who are younger tend to do better than those who are older. People who have better kidney function also tend to do better than those whose kidneys are more affected by the myeloma. 

Talking with your healthcare provider

Once your cancer is staged, your healthcare provider will talk with you about what the stage means for your treatment. Make sure to ask any questions or talk about your concerns.


March 21, 2017


Staging and Prognostic Studies in Multiple Myeloma. UpToDate.

Reviewed By:  

Alteri, Rick, MD,Gersten, Todd, MD