Multiple Myeloma Stages: That Should be Known

Multiple myeloma stages - Under the stage of the malignant process means its scale. Setting the stage of the disease, doctors determine whether the tumor is localized within a single organ, or patient's present metastasis to adjacent tissues and other parts of the body. Stages of multiple myeloma classified depending on lesions of the internal organs, particularly the bones of the skeleton. Stage myeloma has a significant impact on the choice of treatment largely determines the overall prognosis. In Sheba hospital to determine the stage of myeloma is the international scale, taking into account the content in the serum albumin and beta-2-microglobulin. Multiple myeloma metastasis - Until recently, clinical practice has used a system of Durie-Salmon based on other parameters. Knowing the stage of the disease and its characteristics is necessary for the patient to better navigate the treatment process, to participate in the development of treatment strategies and make a correct understanding of disease prognosis.
Multiple Myeloma Stages

Multiple Myeloma Stages: System Durie-Salmon

In patients with multiple myeloma to determine the stage of the disease system Durie-Salmon considers the following parameters:
  • The contents of monoclonal antibodies in serum or urine. The high concentration of the monoclonal antibody indicates the presence in plasma of a large number of malignant cells, pathological monoklonale synthesizing antibodies.
  • The concentration of calcium in serum. High level of calcium is due to destruction of bone tissue. The bones of the skeleton contain a large amount of calcium, and the destruction of the bone calcium is released into the bloodstream, so its level in plasma increases.
  • Foci of bone destruction visible on x-ray. Multiple lesions indicate an advanced stage of myeloma.
  • The level of hemoglobin. Low hemoglobin level (anemia) is a clinical indicator of the vastness of multiple myeloma and is due to the fact that a large part of the affected bone marrow the malignant process and not capable of full blood.
  • Depending on the severity of these signs in a patient with myeloma stage of disease is classified as localized (I) medium (II) or extensive (III).
Stage I: The total number of malignant cells is small. The patient has all the symptoms listed below:
  • Hemoglobin level reduced slightly and is more than 10 g/DL
  • X-rays of normal bone, or present isolated foci of destruction
  • The level of calcium in blood serum in normal (not more than 12 mg/DL)
  • In the blood or in the urine there are small amounts of monoclonal antibodies

Stage II: The total number of malignant cells moderate. Stage II represents an intermediate state between the I and III stages.

Stage III: The total number of malignant cells high. The patient has one of the following or their combination:
  • Low hemoglobin level (less than 8.5 mg/DL)
  • High concentration of calcium in the blood serum (more than 12 mg/DL)
  • Three or more foci of bone destruction
  • A large number of monoclonal antibodies in the blood or urine

International Classification System Stages Multiple Myeloma

On the international scale, traditionally used in Israel, myeloma is divided into three stages based only on 2 indicators: the level of serum albumin and beta-2-microglobulin.

Stage I: The concentration of beta-2-microglobulin in the blood does not exceed 3.5 mg/l, and the concentration of albumin is not less than 3.5 g/L.

Stage II: The concentration of beta-2-microglobulin in the blood is between 3.5 to 5.5 mg/l at any level of albumin, or the concentration of albumin is less than 3.5 g/l when the concentration of beta-2-microglobulin less than 3.5 mg/L.

Stage III: The level of beta-2-microglobulin in the blood serum exceeds 5.5 mg/L.

Prognostic factors
In addition to the stage of multiple myeloma, the prognosis of the disease is influenced by various factors:
  • The functional ability of the kidneys. Indicator of kidney function is the creatinine level in blood serum. If the destruction of the tissues of the kidneys monoclonal antibodies, the functional ability of the kidneys decreases and blood increases the content of creatinine.
  • The age of the patient. The research results indicate that mortality is higher in elderly patients.
  • The index labels plasma cells. The index shows the growth rate of malignant cells. For diagnosis using a sample of bone marrow containing myeloma cells. High index label plasma cells is a poor prognostic sign.
  • Chromosomal mutation. Diagnosis of specific changes in the DNA of malignant cells is an important information for doctors evaluating the prognosis of the disease. So, for example, patients with mutations in the 13-chromosome is much higher mortality from multiple myeloma. Also a bad prognostic sign is translocation in the 4th and 14th chromosomes (a pathological condition in which chromosomes are spontaneously exchanging DNA). As a material for genetic analysis uses a sample of bone marrow, which is produced in the process of puncture.