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Plasma Cell Neoplasms (Including Multiple Myeloma) Treatment (PDQ®)

Patient Version
Last Modified: 10/12/2011

Stages of Plasma Cell Neoplasms

Key Points for This Section


After multiple myeloma and other plasma cell neoplasms have been diagnosed, tests are done to find out the amount of cancer in the body.

The process used to find out the amount of cancer in the body is called staging. It is important to know the stage in order to plan treatment. The following tests and procedures may be used in the staging process:

  • Skeletal bone survey: A skeletal bone survey is a series of x-rays. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body. The x-rays are used to find areas where the bone is damaged. In a skeletal bone survey, x-rays of all the bones in the body are taken. These include the skull, spine, pelvis, ribs, and upper arm and leg bones.
  • MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body such as the bone marrow. This procedure is also called nuclear magnetic resonance imaging (NMRI).
  • Bone densitometry: A procedure that uses a special type of x-ray to measure bone loss.

Certain tests may be repeated to see how well the treatment is working.

The stage of multiple myeloma is based on the levels of beta-2-microglobulin and albumin in the blood.

Beta-2-microglobulin and albumin are found in the blood. Beta-2-microglobulin is a protein found on the surface of plasma cells. Albumin makes up the biggest part of the blood plasma. It keeps fluid from leaking out of blood vessels, brings nutrients to tissues, and carries hormones, vitamins, drugs, and other substances, such as calcium, throughout the body. The amount of beta-2-microglobulin is increased and the amount of albumin is decreased in the blood of patients with multiple myeloma.

The following stages are used for multiple myeloma:

Stage I multiple myeloma

In stage I multiple myeloma, the blood levels are as follows:

Stage II multiple myeloma

In stage II multiple myeloma, the blood levels are as follows:

  • beta-2-microglobulin level is lower than 3.5 g/mL and the albumin level is lower than 3.5 g/dL; or
  • beta-2-microglobulin level is as high as 3.5 g/mL but lower than 5.5 g/mL.

Stage III multiple myeloma

In stage III multiple myeloma, the blood level of beta-2-microglobulin is 5.5 g/mL or higher.

The stages of other plasma cell neoplasms are different from the stages of multiple myeloma.

Isolated plasmacytoma of bone

In isolated plasmacytoma of bone, one plasma cell tumor is found in the bone, less than 5% of the bone marrow is made up of plasma cells, and there are no other signs of cancer.

Extramedullary plasmacytoma

One plasma cell tumor is found in the soft tissue but not in the bone or the bone marrow.

Macroglobulinemia

There is no standard staging system for macroglobulinemia.

Monoclonal Gammopathy of Undetermined Significance

In monoclonal gammopathy of undetermined significance (MGUS), less than 10% of the bone marrow is made up of plasma cells, there is M protein in the blood, and there are no signs of cancer.



Glossary Terms

beta-2-microglobulin (BAY-tuh-2-MY-kroh-GLAH-byoo-lin)
A small protein normally found on the surface of many cells, including lymphocytes, and in small amounts in the blood and urine. An increased amount in the blood or urine may be a sign of certain diseases, including some types of cancer, such as multiple myeloma or lymphoma.
blood (blud)
A tissue with red blood cells, white blood cells, platelets, and other substances suspended in fluid called plasma. Blood takes oxygen and nutrients to the tissues, and carries away wastes.
blood vessel (blud VEH-sel)
A tube through which the blood circulates in the body. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins.
bone marrow (bone MAYR-oh)
The soft, sponge-like tissue in the center of most bones. It produces white blood cells, red blood cells, and platelets.
calcium (KAL-see-um)
A mineral needed for healthy teeth, bones, and other body tissues. It is the most common mineral in the body. A deposit of calcium in body tissues, such as breast tissue, may be a sign of disease.
cancer (KAN-ser)
A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is a cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is a cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is a cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord. Also called malignancy.
drug (drug)
Any substance, other than food, that is used to prevent, diagnose, treat or relieve symptoms of a disease or abnormal condition. Also refers to a substance that alters mood or body function, or that can be habit-forming or addictive, especially a narcotic.
fluid (FLOO-id)
A substance that flows smoothly and takes the shape of its container. Liquids and gases are fluids.
hormone (HOR-mone)
One of many chemicals made by glands in the body. Hormones circulate in the bloodstream and control the actions of certain cells or organs. Some hormones can also be made in the laboratory.
M protein (... PROH-teen)
An antibody found in unusually large amounts in the blood or urine of people with multiple myeloma and other types of plasma cell tumors. Also called monoclonal protein.
macroglobulinemia (MA-kroh-GLAH-byoo-lih-NEE-mee-uh)
A condition in which the blood contains high levels of large proteins and is too thick to flow through small blood vessels. One type is Waldenström macroglobulinemia, which is a type of cancer.
monoclonal gammopathy of undetermined significance (MAH-noh-KLOH-nul ga-MAH-puh-thee ... UN-deh-TER-mind sig-NIH-fih-kunts)
A benign condition in which there is a higher-than-normal level of a protein called M protein in the blood. Patients with monoclonal gammopathy of undetermined significance are at an increased risk of developing cancer. Also called MGUS.
MRI
A procedure in which radio waves and a powerful magnet linked to a computer are used to create detailed pictures of areas inside the body. These pictures can show the difference between normal and diseased tissue. MRI makes better images of organs and soft tissue than other scanning techniques, such as computed tomography (CT) or x-ray. MRI is especially useful for imaging the brain, the spine, the soft tissue of joints, and the inside of bones. Also called magnetic resonance imaging, NMRI, and nuclear magnetic resonance imaging.
nutrient (NOO-tree-ent)
A chemical compound (such as protein, fat, carbohydrate, vitamin, or mineral) contained in foods. These compounds are used by the body to function and grow.
pelvis (PEL-vus)
The lower part of the abdomen, located between the hip bones.
plasma (PLAZ-muh)
The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma.
plasma cell (PLAZ-muh sel)
A type of immune cell that makes large amounts of a specific antibody. Plasma cells develop from B cells that have been activated. A plasma cell is a type of white blood cell. Also called plasmacyte.
plasma cell tumor (PLAZ-muh sel TOO-mer)
A tumor that begins in plasma cells (white blood cells that produce antibodies). Multiple myeloma, monoclonal gammopathy of undetermined significance (MGUS), and plasmacytoma are types of plasma cell tumors.
plasmacytoma (PLAZ-muh-sy-TOH-muh)
A type of cancer that begins in plasma cells (white blood cells that produce antibodies). A plasmacytoma may turn into multiple myeloma.
protein (PROH-teen)
A molecule made up of amino acids that are needed for the body to function properly. Proteins are the basis of body structures such as skin and hair and of substances such as enzymes, cytokines, and antibodies.
serum albumin (SEER-um al-BYOO-min)
The main protein in blood plasma. Low levels of serum albumin occur in people with malnutrition, inflammation, and serious liver and kidney disease.
skeletal (SKEH-leh-tul)
Having to do with the skeleton (bones of the body).
soft tissue (... TIH-shoo)
Refers to muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body.
spine (spine)
The bones, muscles, tendons, and other tissues that reach from the base of the skull to the tailbone. The spine encloses the spinal cord and the fluid surrounding the spinal cord. Also called backbone, spinal column, and vertebral column.
stage (stayj)
The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer, and whether the cancer has spread from the original site to other parts of the body.
stage I multiple myeloma (... MUL-tih-pul MY-eh-LOH-muh)
Relatively few cancer cells have spread throughout the body. There may be no symptoms of disease.
stage II multiple myeloma (... MUL-tih-pul MY-eh-LOH-muh)
Cancer in which a moderate number of cancer cells have spread throughout the body.
stage III multiple myeloma (... MUL-tih-pul MY-eh-LOH-muh)
A relatively large number of cancer cells have spread throughout the body. There may be one or more of the following: 1) a decrease in the number of red blood cells, causing anemia; 2) the amount of calcium in the blood is very high, because the bones are being damaged; 3) more than three bone tumors (plasmacytomas) are found; or 4) high levels of M protein are found in the blood or urine.
staging (STAY-jing)
Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from the original site to other parts of the body. It is important to know the stage of the disease in order to plan the best treatment.
vitamin (VY-tuh-min)
A nutrient that the body needs in small amounts to function and stay healthy. Sources of vitamins are plant and animal food products and dietary supplements. Some vitamins are made in the human body from food products. Vitamins are either fat-soluble (can dissolve in fats and oils) or water-soluble (can dissolve in water). Excess fat-soluble vitamins are stored in the body’s fatty tissue, but excess water-soluble vitamins are removed in the urine. Examples are vitamin A, vitamin C, and vitamin E.
x-ray (EX-ray)
A type of radiation used in the diagnosis and treatment of cancer and other diseases. In low doses, x-rays are used to diagnose diseases by making pictures of the inside of the body. In high doses, x-rays are used to treat cancer.