Once a patient has been diagnosed with multiple myeloma, physicians determine the stage of the patient's disease — a description of how much disease is present and whether it has affected the bones or bone marrow. This information helps physicians select a treatment and determine the prognosis (or outlook) of the patient.
There are two major categories of myeloma — smoldering (inactive) myeloma and active disease.
Patients who have no symptoms of organ damage and whose myeloma protein levels are stable have what's called smoldering or inactive myeloma. Physicians follow these patients closely and usually offer them vaccinations against infection and provide them with bone-strengthening medicines (called bisphosphonates), if indicated.
Patients with symptoms of organ damage and elevated protein levels in blood and urine have active disease and need to receive treatment. Doctors use the International Staging System (ISS) to denote the extent of disease in patients with active myeloma. They rely on the results of blood tests (albumin and beta 2 microglobulin) to assign each patient to one of three disease stages.
Physicians use other prognostic markers to determine whether patients will benefit from certain treatments. For example, patients whose myeloma cells contain chromosomal abnormalities (such as exchanges between chromosomes 4 and 14, or loss of the short arm of chromosome 17, or many complex chromosomal breaks) have poorer outcomes than patients without these markers.