Myeloma, Myeloma Cells and Stages of Myeloma:
Myeloma is a type of cancer, the staging of myeloma is important to physicians because it gives them information about the extent and spread of the disease, prognosis, as well as options for treatment.
The stage of a cancer tells your doctor how far it has grown or spread. The tests and scans you have when diagnosing your myeloma give some information about the stage. This information helps your specialist plan the treatment that is most appropriate for you.
There are currently 2 staging systems doctors use for myeloma
- The International Staging System
- The Durie-Salmon staging system
The International Staging System
This is the system that has now replaced the older Durie-Salmon system. In 2003 a group of specialists from around the world proposed a system which uses tests that may help to indicate your prognosis. This is called the International Staging System (ISS) and looks at the results of 2 blood tests as part of staging. These blood tests are ß2-microglobulin (ß2-M) and albumin. The ISS has 3 stages
- Stage 1 – The level of the protein called beta 2 microglobulin (ß2-microglobulin or ß2-M) is less than 3.5 mg per litre. And the level of albumin in the blood is more than 3.5 grams per decilitre.
- Stage 2 – The levels of beta 2 microglobulin and albumin fall between those in stages 1 and 3.
- Stage 3 – The level of the protein beta 2 microglobulin is more than 5.5 mg per litre.
Doctors now use this system to help them predict how you might respond to treatment.
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The Durie-Salmon staging system
This system has been used for many years but is now rarely used. There are 3 stages in this system.
- No anaemia (in other words, a normal red blood cell count)
- A normal level of blood calcium
- Low levels of abnormal antibodies (immunoglobulin) in your blood or urine
- No bone damage, or a solitary plasmacytoma
Stage 1 is then divided into A and B. Group A is the people with cancer whose kidneys are working normally. Group B is for people who have some kidney damages or kidney failure. This is measured and assessed by a blood test.
Stage 2 includes anyone who does not fit exactly into stage 1 or stage 3. So, you would be stage 2 if you had 2 areas of bone damage. You can also have stage 2A or 2B. As with stage 1, this depends on whether your kidneys have been damaged at all by the myeloma.
This is if you have
- Anaemia (low red cell count)
- High levels of calcium in your blood
- More than 3 sites of bone damage
- High levels of abnormal paraproteins in your blood or urine
Stage 3 is also divided into stages 3A and 3B, with those in 3B having a high creatinine level in their blood, indicating that they have some kidney damage from their myeloma.
The below table summarizes staging of myeloma: