Staging for Multiple Myeloma

Once multiple myeloma has been diagnosed, detailed tests are performed to evaluate the extent of the disease (called staging). Information about the stage of the cancer is used to develop a treatment plan and determine the expected outcome (prognosis).

Multiple myeloma is staged using either the Durie-Salmon Staging System or the International Staging System for Multiple Myeloma. Using the Durie-Salmon system, blood levels of calcium and hemoglobin (substance found in red blood cells that transports oxygen) and blood and urine levels of M proteins are measured and x-rays are taken to evaluate bone damage. Using the International Staging System for Multiple Myeloma, the cancer is staged based on levels of certain proteins (e.g., albumin, beta-2 microglobulin) in the blood.

Stage I multiple myeloma (characterized as early disease) involves the following:

Durie-Salmon Staging System

  • Hemoglobin level slightly lower than normal (> 10 g/dL)
  • Normal x-rays or one bone lesion
  • Normal blood calcium level (< 12 mg/dL)
  • Slightly elevated level of M proteins in the blood or urine

International Staging System for Multiple Myeloma

  • Blood level of beta-2 microglobulin < 3.5 mg/L and albumin level > 3.5

Stage II multiple myeloma (characterized as moderate disease) involves the following:

Durie-Salmon Staging System

  • Hemoglobin, calcium, and M protein levels are between Stage I and Stage III levels and x-rays show fewer than three bone lesions

International Staging System for Multiple Myeloma

  • Blood level of beta-2 microglobulin between 3.5 mg/L and 5.5 mg/L (with any albumin level) or albumin level < 3.5 mg/L with beta-2 microglobulin level < 3.5 mg/L

Stage III multiple myeloma (characterized as advanced disease) involves the following:

Durie-Salmon Staging System

  • Hemoglobin level < 8.5 g/dL
  • Blood calcium level > 12 mg/dL
  • Three or more bone lesions
  • High levels of M proteins in the blood or urine

International Staging System for Multiple Myeloma

  • Blood level of beta-2 microglobulin > 5.5 mg/L

Publication Review By: Stanley J. Swierzewski, III, M.D.

Published: 02 Jul 2009

Last Modified: 14 Sep 2010