Symptoms and Tests | Diagnosis Staging

I've received a Myeloma diagnosis. What's next?

Once you've completed diagnostic testing, your doctor will review the results with you. If your doctor confirms a diagnosis of myeloma, diagnostic tests are also used to confirm the stage of cancer. Cancer stage is used to describe the location of cancer, if and where it has spread, and if it's potentially affecting any other body parts. Cancer staging can be complex, so ask your doctor to explain it to you in detail. Be sure to ask questions if there's anything you don't understand.

A person that's newly diagnosed with myeloma is either:

Asymptomatic with no symptoms or signs of the disease
Symptomatic and experiencing signs/symptoms of the disease

Myeloma symptoms are described using the acronym "CRAB"

Calcium levels are high (hypercalcemia) where serum calcium level > 0.25 mmol/L above the upper limit of normal or a level that is > 2.75 mmol/L
Renal (kidney) issues with a creatinine level > 173 mmol/L
Anemia (low hemoglobin level), which is 2 g/dL < the lower limit of normal or a hemoglobin level that is < 10 g/dL
Bone pain/lesions, including lytic lesions, osteoporosis or compression fractures of the spine

Additional symptoms include hyperviscosity (thickening of the blood), amyloidosis (when an abnormal protein called amyloid builds up in your organs), and multiple bacterial infections. Active treatment is recommended for patients with 1 or more CRAB symptoms. People with no CRAB symptoms may also receive treatment if:

> than 60% of bone marrow cells are plasma cells
Serum testing shows that the involved-to-uninvolved free light chain ratio is > 100 with absolute values > 100 mg/L or 10 mg/dL. Light chains are antibody fragments that are a product of cancerous plasma cells.
MRI or PET-CT scans show bone lesions

Revised International Staging System (R-ISS)

This type of staging is commonly used to classify multiple myeloma, predict prognosis and is based on the measurement of serum albumin, LDH, serum β2-M, and cytogenetic results.

Stage I

Serum beta-2 microglobulin < 3.5 mg/L
Albumin level ≥ 3.5 g/dL
Normal LDH
Cytogenetics are not high risk

Stage II

Not stage I or stage III

Stage III

Serum beta-2 microglobulin is > 5.5 mg/L AND:

Cytogenetics are considered high-risk AND/OR
High LDH

Recurrent or Relapsed Myeloma

This is myeloma that was in control after treatment but then returns after a period of time. The cancer may need to be staged again if there's a recurrence.

For additional information on staging, please click here