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Cancer Staging Systems

Staging of Multiple Myeloma

Stage I multiple myeloma

Stage I multiple myeloma means all of the following:

1. Hemoglobin greater than 10 g/dL.
2. Normal serum calcium.
3. Normal bone structure.
4. Low M-protein production as shown by:
   1. IgG less than 5.0 g/dL.
   2. IgA less than 3.0 g/dL.
   3. Urinary κ or λ less than 4 g/24 hours.

Estimated myeloma cell mass: less than 0.6 trillion (10¹²)/m² (low burden).

The following subclassification of stages is used:

1. Creatinine less than 2.0 mg/dL.
2. Creatinine greater than or equal to 2.0 mg/dL.

Impaired renal function worsens prognosis regardless of stage.

Stage II multiple myeloma

Stage II multiple myeloma means multiple myeloma that fits in neither stage I nor stage III.

Estimated myeloma cell mass: 0.6 to 1.2 trillion (10¹²)/m² (intermediate burden).

The following subclassification of stages is used:

1. Creatinine less than 2.0 mg/dL.
2. Creatinine greater than or equal to 2.0 mg/dL.

Impaired renal function worsens prognosis regardless of stage.

Stage III multiple myeloma

Stage III multiple myeloma means 1 or more of the following:

1. Hemoglobin less than 8.5 g/dL.
2. Serum calcium greater than 12.0 mg/dL.
3. More than 3 lytic bone lesions.
4. High M-protein production as shown by:
   1. IgG greater than 7.0 g/dL.
   2. IgA greater than 5.0 g/dL.
   3. Urinary κ or λ greater than 12.0 g/24 hours.

Estimated myeloma cell mass: greater than 1.2 trillion (10¹²)/m² (high burden).

The following subclassification of stages is used:

1. Creatinine less than 2.0 mg/dL.
2. Creatinine greater than or equal to 2.0 mg/dL.

Please refer to the NCI PDQ summary for updates on multiple myeloma

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