Staging of myeloma

What is myeloma staging?

The stage describes how advanced the myeloma may be and how effective treatment might be.

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Types of myeloma

International Staging System (ISS) for myeloma

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)
Stage 2	Normal or near normal (less than 3.5)	Low (less than 3.5)
	OR
	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.

CRAB criteria for myeloma

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.

About our information

References

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 cancerinformationteam@macmillan.org.uk

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

Reviewers

This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr Anne Parker, Consultant Haematologist.

Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.

The language we use

We want everyone affected by cancer to feel our information is written for them.

We want our information to be as clear as possible. To do this, we try to:

use plain English
explain medical words
use short sentences
use illustrations to explain text
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make sure important points are clear.

We use gender-inclusive language and talk to our readers as ‘you’ so that everyone feels included. Where clinically necessary we use the terms ‘men’ and ‘women’ or ‘male’ and ‘female’. For example, we do so when talking about parts of the body or mentioning statistics or research about who is affected.

You can read more about how we produce our information here.