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Multiple Myeloma Stages

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Multiple myeloma is a slowly spreading cancer of the plasma cells. It is usually found in adults above 65 years. Multiple myeloma is a rare hematological malignancy. This means it affects cellular system of the body. In this disease the DNA of plasma cells is damaged such that it creates rapidly dividing plasma cells. These cells generate certain proteins known as antibodies. They are developed in the bone marrow. This reduces number of healthy plasma cells and slowly weakens the bones. As bone structure collapses it disintegrates and degenerates into calcium. Excess calcium damages organs like the stomach, liver and the kidneys. This makes treating multiple organs or the whole body a difficult task. Therefore, multiple myeloma must be detected in early stages.

Stages of multiple myeloma: Stages of multiple myeloma refer to the progress and impact of the disease on the body. Staging is done using numerals such stage 1 through stage 4. Staging helps predicting the course of the disease.

Staging answers to following questions,

  • What is the impact of multiple myeloma and what more diagnostics should be undertaken
  • What are the risks of multiple myeloma
  • How many organs are affected
  • What is the rate of spreading of the multiple myeloma
  • What are the chances of survival for the patient and how can they be increased

Thus, staging is of critical importance both from doctors and patients' point of view. Systems such as International Staging System (ISS) and Durie Salmon Staging System (DSS) are used to describe multiple myeloma. International Staging System: Unlike many other forms of cancers in which particular organs are affected, multiple myeloma impacts multiple organs. Moreover, it damages plasma cells and bones present throughout the body. This makes staging extremely difficult. While other staging systems prefer to describe the cancer by tumor size, its spread and effect on other organs multiple myeloma staging uses microglobulin and albumin levels to describe the cancer. The International Staging System was developed by International Myeloma Working Group considering these factors. The staging system can be described as below,

  • Stage I: β2 microglobulin (β2M) less than 3.5 mg/L with albumin greater than 3.5 g/dL
  • Stage II: β2M less than 3.5 mg/L with albumin less than 3.5 g/dL or β2M 3.5 mg/L to 5.5 mg/L (without considering the serum albumin)
  • Stage III: β2M greater than 5.5 mg/L

The ISS system is not useful for patients with other diseases such as diabetes, hypertension and renal dysfunction. One of the disadvantages of this system is that it does not describe tumors and the extent to which they spread. However it does manage to estimate a correct prognosis for multiple myeloma patients. To counter the limitations of ISS system, durie salmon staging system is also used to get a clear idea of the cancer.

Durie Salmon Staging System: Besides microglobulin and albumin levels it also takes into consideration bone damage and presence of bone lesions or bone degradation. DSS system also takes into account presence of calcium and urinary light chains.

Stage I:

  • All of Hb greater than 10g/dL
  • Normal level of calcium
  • Skeletal survey shows normal or single plasmacytoma or osteoporosis
  • Serum paraprotein level less than 5 g/dL, if IgG chromosomes are found and less than 3 g/dL, if IgA is found
  • Urinary light chain excretion is less than 4 g/24h

Stage 2: Stage 2 is said to be when the all the above mentioned quantities do not fit in either stage 1 or stage 3

Stage 3:

  • One or more of Hb less than 8.5g/dL
  • Calcium level greater than 12 mg/dL
  • Skeletal survey shows three or more bone lesions of lytic nature
  • Serum paraprotein greater than 7g/dL if IgG are found or greater than 5 g/dL if IgA is found
  • Urinary light chain excretion > 12g/24h
All stages of the Durie-Salmon staging system can be further grouped into A or B based on serum creatinine levels
  • Group A: If serum creatinine is less than 2 mg/dL
  • Group B: If serum creatinine is less than 2 mg/dL

Thus, multiple myeloma stages help in a good way to decide your treatment options and cope with the disease in a positive way.

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