Staging and prognosis for myeloma

The test results allow the haematologist to work out how far the disease has progressed. This process is called staging, and the information will help your doctor assign a stage to the myeloma. This is an indication of how much the myeloma has affected your body and how it is likely to respond to treatment.

If you have difficulty understanding the stage of the myeloma, ask your doctor to explain it in simple terms.

Learn more about:

Staging
Significant signs of myeloma
Prognosis
When to start treatment

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Staging

The most commonly used staging system for myeloma is the Revised International Staging System (R-ISS).

The R-ISS divides myeloma into stages I, II and III based on the results of various blood tests that check:

levels of beta-2 microglobulin (ß2M) – a protein produced by myeloma cells that indicates the extent of disease
levels of albumin – a protein produced by the liver that indicates overall health
levels of lactate dehydrogenase (LDH) – an enzyme released into the blood when cells are damaged or destroyed
genetic information – the presence of one or more specific chromosomal abnormalities may identify people at highest risk of the disease progressing.

Significant signs of myeloma

Doctors usually use the CRAB criteria of myeloma-defining events to help identify people with myeloma who need to start treatment. The SLiM criteria was added as part of the R-ISS and consists of a set of three specific signs known as biomarkers. When used together, the criteria are known as the SLiM-CRAB criteria.

CRAB criteria: myeloma-defining events
C	increase in calcium level in blood
R	renal (kidney) damage
A	anaemia (low levels of red blood cells)
B	bone 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	significant plasmacytosis (more than 60% of abnormal plasma cells in the bone marrow)
Li	light chain ratio (a high level of free light chains in the blood)
M	MRI lesions (more than one area of bone abnormality found by MRI – this is called a focal lesion and must be 5 mm or more in size)

Prognosis

Prognosis means the expected outcome of a disease. It is not possible for any doctor to predict the exact course of the disease, 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 also have tests throughout your treatment that show how well the treatment is working.

The outlook for people with myeloma is improving constantly. While treatment cannot 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 much longer periods. When the disease becomes active again (disease progression, also called relapse or recurrence), further treatment will be needed.

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.

This information was last reviewed in October 2018. View who reviewed this content.

Dr Jane Estell, Senior Staff Specialist, Haematology Department, Concord Cancer Centre, and Senior Clinical Lecturer, The University of Sydney; Brenda Clasquin, 13 11 20 Consultant, Cancer Council NSW; Jacqui Keogh, Senior Myeloma Support Nurse, Myeloma Australia; Dr Silvia Ling, Haematologist, Liverpool Hospital and Sydney Adventist Hospital; and John Miller, Consumer.

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