Staging Multiple Myeloma

If you are diagnosed with multiple myeloma, your doctor must determine the extent — or stage — of the disease in order to formulate the best treatment plan. The stage takes into account whether the cancer is causing problems with your bones or kidneys. Staging multiple myeloma usually involves having more tests and these can include:

• Blood tests: For correct staging of the disease, the doctor considers the results of various blood tests, including the levels of serum albumin and beta-2 microglobulin (β2-M). Other tests that may be necessary include measuring your platelet count and kidney function.
• CT scan: An X-ray machine that is linked to a computer takes a series of detailed pictures of your bones. This test is painless and takes less than an hour.
• MRI: A powerful magnet linked to a computer is used to make detailed pictures of your bones. This test is also pain-free and generally takes about an hour.

Patients with multiple myeloma may not experience symptoms. These patients are often in the earlier stages of the disease and may be one of the following stages:

• Smoldering: This stage is the earliest one for this disease, and generally you will show no symptoms, such as bone damage. Often, your oncologist or hematologist will simply keep a close watch on you, since the disease may not worsen for months or years. They may suggest a therapy that will slow the growth of the cancer cells. Generally, more testing is done every three months to monitor the development of bone lesions and reduction of kidney function.
• Stage I: β2-M less than 3.5 mg/L with a serum albumin of 3.5 g/dL or more. Your oncologist may choose to monitor the disease if there are no symptoms. Once symptoms are evident, treatment for multiple myeloma is likely to begin.

Patients who experience multiple myeloma symptoms typically have them in one or more of the following ways:

1. Calcium levels are increased – This is defined as a serum calcium level is greater than 0.25 mmol/L above the upper limit of normal or a level that is greater than 2.75 mmol/L.
2. Renal problems (kidneys) – Creatinine is greater than 173 mmol/L.
3. Anemia – A low hemoglobin level, which is 2 g/dL below the lower limit of normal or a hemoglobin level that is less than 10 g/dL.
4. Bone lesions include:
   • lytic lesions (areas of bone damage)
   • osteoporosis (thinning of the bones)
   • compression fracture of the spine

• Stage II: Either of these two test results:
  • β2-M between 3.5 mg/L and 5.5 mg/dL
  • Albumin is less than 3.5 g/dL
• Stage III: β2-M is greater than 5.5 mg/L.