Staging and prognosis for myeloma
These tests allow your doctor to work out how far the myeloma has progressed. Called staging, this is an indication of how much the myeloma has affected your body and how it is likely to respond to treatment.
Learn more about:
- R-ISS staging system of myeloma
- Significant signs of myeloma
- When to start treatment
Blood cancers are staged differently to solid tumours like breast or lung cancer. Doctors look at blood test results rather than at the size and spread of the cancer. If you have any difficulty understanding the stage of the myeloma, ask your doctor to explain it in simple terms.
The most commonly used staging system for myeloma is the Revised International Staging System (R-ISS).
The R-ISS divides myeloma into three stages. Stage 1 is the earliest stage and stage 3 is more advanced.
The stages are based on the results of various blood tests that check:
- levels of beta-2 microglobulin (B2M) – a protein produced by myeloma cells that shows the extent of certain diseases
- levels of albumin – a protein produced by the liver that is a sign of overall health
- levels of lactate dehydrogenase (LDH) – an enzyme released into the blood when cells are damaged or destroyed
- genetic information – specific chromosomal abnormalities that identify people at risk of the disease progressing.
R-ISS staging system of myeloma
Significant signs of myeloma
Doctors usually use the CRAB system to help identify people with myeloma who need to start treatment. The SLiM criteria were added as part of staging and have three specific signs known as biomarkers. When used together, the criteria are known as the SLiM–CRAB criteria.
CRAB criteria: myeloma-defining events
|C||calcium levels in the blood are raised|
|R||renal (kidney) damage|
|A||anaemia (low levels of red blood cells)|
|B||bone pain and damage (areas of damage known as lytic lesions and/or bone loss known as osteoporosis can weaken bones making them more likely to fracture)|
SLiM criteria: biomarkers of malignancy
|S||60% or more abnormal plasma cells in the bone marrow (plasmacytosis)|
|Li||light chain ratio (a high level of free light chains in the blood)|
|M||MRI lesions (bone abnormalities found by MRI of 5 mm or more in size)|
Prognosis means the expected outcome of a disease. It is not possible for any doctor to predict the exact course cancer will take, but your medical team can predict how the myeloma will respond to treatment based on several factors:
- your test results
- the type of myeloma you have, and its stage and rate of growth
- your age, fitness and medical history.
You will continue to have tests during treatment to check how well it’s working.
The outlook for people with myeloma is improving all the time. Even though treatment can’t cure myeloma, it can help control the disease (known as plateau phase or remission).
If the myeloma is under control, symptoms improve and people usually return to a state of good health that may last for months or a few years. For some people, the disease can be controlled for even longer periods.
When myeloma becomes active again it is called disease progression, or a relapse or recurrence. You will need to have further treatment when this happens.
Living with myeloma may make you feel anxious. It may help to talk to a myeloma support nurse or contact the hospital social worker or psychologist for support. You can also speak to other people who have myeloma – for more on this, see Myeloma Australia.
Podcast: Tests and Cancer
Dr Ian Bilmon, Haematologist, Westmead Hospital and The Sydney Adventist Hospital; Martin Boling, Consumer; Catherine Bowley, Myeloma Support Nurse, Myeloma Australia; Dr Samuel Dickson, Radiation Oncologist, Calvary Mater Newcastle; Rachelle Frith, Clinical Nurse Consultant, Haematology, Prince of Wales Hospital; Dr Wojt Janowski, Haematologist, Calvary Mater Newcastle; Yvonne King, 13 11 20 Consultant, Cancer Council NSW.
View the Cancer Council NSW editorial policy.
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