Multiple myeloma

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Staging multiple myeloma

Staging is a way of describing or classifying a cancer based on the extent of cancer in the body. Extent refers to how much cancer is in the body, the location of the cancer and how far it has spread into nearby tissue or distant areas of the body. By the time multiple myeloma is diagnosed, the cancer is usually widespread. Staging multiple myeloma is based on the results of blood and imaging tests. Results of other tests can also help determine the stage depending on the system used.

Doctors use 2 systems to stage multiple myeloma:

  • International Staging System (ISS)
  • Durie-Salmon staging system

In Canada, multiple myeloma is most often staged using the International Staging System.

Stage grouping for multiple myeloma

Each stage is given a number from 1 to 3 shown as a Roman numeral (I, II or III). Generally, the higher the number, the more advanced the cancer. Your healthcare team uses the stage grouping to plan treatment and make a prognosis.

International Staging System

The International Staging System uses the results of 2 blood tests to stage multiple myeloma:

  • albumin – the main protein found in plasma that helps to maintain blood volume
  • beta-2-microglobulin – a protein found on the surface of cells that plays a role in the immune response

International Staging System
ISS stageDescription


The beta-2-microglobulin level is less than 3.5 mg/L.

The albumin level is 35 g/L or more.


The beta-2-microglobulin level is less than 3.5 mg/L.

The albumin level is less than 35 g/L.

The beta-2-microglobulin level is more than 3.5 mg/L but less than 5.5 mg/L.


The beta-2-microglobulin level is 5.5 mg/L or more.

The Durie-Salmon staging system

The Durie-Salmon staging system uses the results of the blood tests, urine tests and x-rays to determine the stage of multiple myeloma. The Durie-Salmon staging system is based on the amount of:

  • hemoglobin in the blood
  • calcium in the blood
  • bone damage found on x-rays
  • monoclonal protein (M-protein) in the blood or urine (IgG, IgA, free light chains)

Durie-Salmon staging system
Durie-Salmon stageDescription


There are a small number of myeloma cells.

All of the following features are present:

  • Hemoglobin level is 100 g/L or more.
  • Blood calcium level is normal (less than 2.8 mmol/L).
  • There are no areas of bone damage or there is a solitary plasmacytoma of the bone.
  • IgG level is less than 50 g/L.
  • IgA level is less than 30 g/L.
  • Urine M-protein level is less than 4 g (urine collected over 24 hours).


There are a moderate number of myeloma cells.

The features are between stage I and stage III.


There are a large number of myeloma cells.

One or more of the following features are present:

  • Hemoglobin level is less than 85 g/L.
  • Blood calcium level is more than 2.8 mmol/L.
  • There are several areas of bone damage.
  • IgG level is more than 70 g/L.
  • IgA level is more than 50 g/L.
  • Urine M-protein level is more than 12 g (urine collected over 24 hours).

Substages of Durie-Salmon

The stages of multiple myeloma are further divided according to creatinine level in the blood, which shows how well the kidneys are working.

Substage A

Kidney function is normal. Creatinine level is less than 180 µmol/L.

Substage B

Kidney function is abnormal. Creatinine level is higher than 180 µmol/L.

Relapsed multiple myeloma

Relapsed, or recurrent, multiple myeloma means that the cancer has come back after it has been treated. It may recur in the same location as the original myeloma or it may come back in another part of the body.


The liquid part of blood that carries the blood cells. Plasma contains many proteins and minerals.


A protein found in red blood cells that carries oxygen and gives blood its red colour.


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