Staging

Patients who have abnormal plasma cells can be classified as MGUS, smoldering multiple myeloma or multiple myeloma. Patients who have multiple myeloma (have either high burden of abnormal plasma cells or have symptoms) require treatment. Patients with multiple myeloma are staged using the Revised-International Staging System. This system is based on levels of certain proteins in your blood as well as genetics of your myeloma based on bone marrow biopsy results. Staging is an important step in evaluating prognosis and treatment options. The International Staging System (ISS) has become most commonly used in recent years.

International  Revised Staging System (ISS)

In the International Revised  Staging System (ISS)  The genetics of your myeloma are determined through a bone marrow biopsy.  The stage is determined based on the serum beta-2 microglobulin (B2M) level, the serum albumin level, the LDH level and the myeloma genetics. Albumin is the most common protein found in the blood and is made in the liver. When a person becomes ill, the albumin level begins to decrease, and the lower the level, the greater the degree of illness. B2M is another serum protein that is manufactured by different types of normal or cancerous cells, and is found to be elevated in the blood in many types of blood cancers, including myeloma. LDH is a serum protein that is also manufactured by different types of normal or cancerous cells and is high in blood cancers including myeloma.  Specialized testing called Fluorescence In Situ Hybridization FISH) can identify certain changes in the DNA of the myeloma cancer cells.  The genetic abnormalities of myeloma cells help better understand the biology of the myeloma cells.  Gene Expression Profiling (GEP)  is also used at some institutions. These genetic abnormalities are incorporated into the staging system.