Multiple Myeloma Staging 

Updated: Sep 18, 2015
  • Author: Sara J Grethlein, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Classification for Multiple Myeloma

Staging for multiple myeloma does not use the TNM system. There are several systems in use that characterize the bulk and aggressiveness of the disease. The International Myeloma Working Group diagnostic criteria [1] and the International Staging System (ISS) [2] are commonly used. [3]

International Myeloma Working Group diagnostic criteria

See the list below:

  • Asymptomatic/smoldering myeloma: Monoclonal (M)-protein ≥ 30 g/L and/or bone marrow clonal cells ≥ 10% but no related organ or tissue impairment (ROTI) (end-organ damage)

  • Symptomatic myeloma: M-protein ≥ 30 g/L and/or bone marrow clonal cells ≥ 10% and must have evidence of ROTI (end-organ damage) that can be attributed to the plasma cell proliferative process; manifested by CRAB (calcium, renal failure, anemia, and bone lesions: increased serum calcium ≥ 11.5 mg/100 mL; renal insufficiency [serum creatinine > 1.73 mmol/L]; normochromic, normocytic anemia with a hemoglobin value > 2 g/100 mL below the lower limit of normal or a hemoglobin value < 10 g/100 mL; lytic lesions, severe osteopenia, or pathologic fractures)

  • Nonsecretory myeloma: Absence of an M-protein in the serum and urine, bone marrow plasmacytosis, and ROTI.

International Staging System

See the list below:

  • Stage I: Serum beta-2 microglobulin < 3.5 mg/L and serum albumin ≥ 3.5 g/dL

  • Stage II: Neither stage I nor stage III

  • Stage III: Serum beta-2 microglobulin ≥ 5.5 mg/L