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Before we decide on treatment options, we will need to know the extent, or stage, of the multiple myeloma. We will look at the results of blood tests, imaging tests and bone marrow tests to determine the stage of the cancer. Once we determine the stage, we can plan the most effective treatment for multiple myeloma.
There are two systems to stage multiple myeloma:
Durie-Salmon System of Staging
The Durie-Salmon system is the traditional system used to stage multiple myeloma. It is based on four different factors:
The amount of abnormal monoclonal immunoglobulin in the blood or urine. A large amount of monoclonal immunoglobulin is a sign that many malignant plasma cells are in the blood making this abnormal protein.
The amount of calcium in the blood. High blood calcium levels are also related to advanced bone damage. Bone normally contains a lot of calcium and bone destruction releases calcium into the blood.
The amount of bone damage seen on X-rays. If there are many areas of bone damage, that is a sign of an advanced stage of multiple myeloma.
The amount of hemoglobin in the blood. Hemoglobin is the part of the red blood cell that carries oxygen. Low hemoglobin levels are a sign that the myeloma cells are taking up much of the bone marrow, and there is not enough space left for the normal marrow cells that make red blood cells.
Stages in the Durie-Salmon System
There are three different clinical stages of multiple myeloma in the Durie-Salmon system. Stage I indicates the smallest amount of tumor. Stage III indicates the largest amount of tumor.
Stage I: X-rays and blood tests indicate that only a small number of myeloma cells are present in the body. Most people with this stage do not have symptoms. Your doctor may say that you have a "low tumor burden" at this stage.
Stage II: The myeloma cells have spread through the body a little bit. Your doctor may say that you have an "intermediate tumor burden" at this stage.
Stage III: X-rays and blood tests indicate that many cancer cells are present in the body. Your doctor may say that you have a "high tumor burden" at this stage.
International Staging System
The International Staging System is a newer system now used by many doctors to classify multiple myeloma. This system divides myelomas into three stages based only on the blood levels of beta-2 microglobulin and albumin.
Stage I: The beta-2 microglobulin level is less than 3.5 milligrams/liter (mg/L) and the albumin level is 3.5 grams/deciliter (g/dL) grams or higher.
Stage II: Neither stage I or III, meaning that either:
The beta-2 microglobulin level is between 3.5 and 5.5 (with any albumin level), or
The albumin is below 3.5 while the beta-2 microglobulin is less than 3.5
Stage III: The beta-2 microglobulin level is greater than 5.5.
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