Multiple Myeloma Stages and Subtypes

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Staging is when a system is used to identify and describe how far a cancer has spread in your body. Knowing the stage of your multiple myeloma helps your physicians predict which treatments are most likely to control your disease or put it into remission (when cancer symptoms lessen or go away).

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Multiple Myeloma Stages

Physicians use the Revised International Staging System (R-ISS) to stage multiple myeloma, which is different than systems used to stage other types of cancer. The R-ISS measures four factors in the body — albumin, Beta-2 microglobulin (B2M), lactate dehydrogenase (LDH) and genetic changes — to place the cancer in one of three stages:

Stage I (1)

Levels of albumin, B2M and LDH are normal or close to normal, and the genetic makeup of the cancer cells isn’t aggressive. 

Stage II (2)

The albumin level is low and B2M is either normal or slightly high. 

Stage III (3)

B2M levels are high. LDH levels are high, or cell DNA may show changes. 

Tests to Determine the Stage

To find out the stage of your multiple myeloma, your physician will use these tests. 

Blood Tests

Most patients with multiple myeloma have a protein in their blood that can be measured.

This protein is called a monoclonal protein, or sometimes an M-spike or M-protein.

Blood Testing for Multiple Myeloma

Bone Marrow Biopsy

Bone marrow biopsy and aspiration is a test that is used to check the percentage of plasma cells in the bone marrow.

For people who don’t have multiple myeloma, blood plasma cells make up less than 5% of their cells. For people who have multiple myeloma, bone marrow plasma cell levels usually make up 10% or more of their cells. 

Read About Bone Marrow Biopsies

Imaging Tests

If your disease is advanced, you may have imaging tests so your physician can better determine the stage and see if there is any bone damage or large tumors.

This imaging may be a whole-body low-dose CT scan, PET/CT scan, bone marrow MRI or skeletal survey (series of X-rays). 

Multiple Myeloma Subtypes and Other Plasma Cell Disorders

Multiple myeloma is also divided into subtypes, and each one acts differently. Fred Hutch physicians who specialize in multiple myeloma have a deep knowledge of these subtypes and know which therapies to use and when to use them.

Active Multiple Myeloma

Most patients who get treatment for multiple myeloma have this standard subtype, called active multiple myeloma, which means that the buildup of cancerous plasma cells is causing symptoms. This is also called having symptomatic multiple myeloma.  

Smoldering Myeloma

Smoldering myeloma, also known as asymptomatic myeloma, often occurs before active multiple myeloma. Patients with smoldering myeloma don’t usually get treatment unless they are considered high-risk. Most people with smoldering myeloma will eventually develop active multiple myeloma. 

MGUS

MGUS stands for monoclonal gammopathy of undetermined significance and is a plasma cell disorder. Usually, MGUS is diagnosed when a physician finds abnormal plasma cells during a routine blood test. It’s rare that patients have symptoms from MGUS, and most cases of MGUS does not turn into cancer. However, regular monitoring is important in case it turns into smoldering myeloma, which could later turn into active multiple myeloma. 

Multiple Myeloma Survival Rates

In cancer care, “survival rate” usually means the percentage of people expected to survive their cancer for at least five years from the time it was diagnosed. Data experts estimate this rate based on information about large groups of people with the same type of cancer. The rate doesn’t include the risk of dying during that five years for some other reason. The average five-year relative survival rate for multiple myeloma is approximately 62%, according to the National Cancer Institute (NCI).

It is impossible to predict the likely lifespan of any one person based on survival rates. If you would like to know more about the outlook for your disease, talk to your Fred Hutch care team. They can tell you more based on your unique situation.

Surveillance, Epidemiology, and End Results (SEER) Database

The American Cancer Society uses information from the Surveillance, Epidemiology, and End Results (SEER) database, maintained by the NCI, to show survival percentages for different types of cancer. SEER tracks five-year relative survival rates for myeloma in the United States, based on how far the cancer has spread. however, SEER, does not group cancers using the R-ISS, but instead, in these stages:

  • Localized: A single tumor is growing in the bone or outside of it.
  • Regional: Myeloma does not spread to the lymph nodes, so this stage does not apply. 
  • Distant: Multiple tumors have grown inside or outside the bones, or multiple myeloma has been diagnosed.

View the 5-Year Relative Survival Rates for Myeloma on the NCI website.

Multiple Myeloma Stages FAQ

Yes, the stage of your myeloma will affect the treatment offered. At first, you may not need to be treated. Later, depending on how your disease is impacting you, you may have medicines or other forms of treatments. Your treatment plan will also be impacted by your age and overall health. Physicians often use a combination of chemotherapy, blood and marrow transplant, immunotherapy and radiation therapy and different stages to treat multiple myeloma.

Fred Hutch researchers are on the forefront of developing treatments for multiple myeloma, and our clinical research teams conduct clinical studies on various kinds of multiple myeloma. 

Although multiple myeloma cannot be cured, it is possible to manage it at all stages, including stage III. At Fred Hutch, our standard always involves caring for you as a whole person. That means, in addition to offering you treatment, we help you get relief from any issues or side effects you may have and provide many other forms of support, like integrative medicine, nutrition counseling and physical therapy.