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.
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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 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||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 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.
Prof John Gibson, Haematologist, Institute of Haematology, Royal Prince Alfred Hospital and The University of Sydney, NSW; Dr Stephanie Anderson, Registrar, Institute of Haematology, Royal Prince Alfred Hospital, NSW; Tanya Carney, Consumer; Jacqui Keogh, NSW State Manager/Senior Myeloma Nurse NSW, Myeloma Australia; Dr Silvia Ling, Haematologist, Liverpool Hospital, NSW; Rachel McCann, Myeloma Support Nurse NSW, Myeloma Australia; John McMath, Consumer; Karen Robinson, 13 11 20 Consultant, Cancer Council NSW.
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