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Diagnosis and Staging



The International Myeloma Foundation is proud to have sponsored and coordinated the development of the International Staging System (ISS) for Multiple Myeloma in 2005. The ISS was developed through a collaborative research initiative conducted by 17 myeloma institutions around the world.  Based on that research, the factors found to best stratify patients’ prognosis into a three-stage classification were two blood proteins: serum beta 2 microglubulin and serum albumin.

In August, 2015 the International Myeloma Working Group (IMWG) published its Revised International Staging System (R-ISS), which combines the ISS with chromosomal abnormalities detected by interphase fluorescent in situ hybridization (FISH) and serum lactate dehydrogenase (LDH). Clinical data from 4,445 patients with newly diagnosed myeloma in 11 international clinical trials were pooled and analyzed to create this updated simple yet powerful prognostic staging system.   



Serum ß2 microglobulin < 3.5 mg/l
Serum albumin ? 3.5 g/dl
Standard-risk chromosomal abnormalities (CA)
Normal LDH

Not R-ISS stage I or III

Serum ß2 microglobulin ? 5.5 mg/L and either
High-risk CA by FISH
High LDH

Related Links:

Understanding Your Test Results

Revised International Staging System for Multiple Myeloma

©2015 International Myeloma Foundation


Blood & Urine

Imaging Studies

  • X-Rays are the first imaging study done to search for myeloma-caused bone damage.  A full skeletal x-ray survey is needed to demonstrate loss or thinning of bone (osteoporosis or osteopenia), holes in bone (lytic lesions),  and/or fractures.  X-rays are simple to do and are inexpensive.  Their limitations are that 30% or more of the bone must be missing before x-ray can reveal the damage, and that damage to a bone shows up permanently on x-ray, even if there is no longer any active myeloma.
  • MRI (Magnetic Resonance Imaging) is a non-invasive study that uses magnetic energy to produce a detailed two- or three-dimensional image of structures inside the body.  It is useful for imaging plasmacytomas (tumors formed from massing of myeloma cells inside or outside the bone marrow); infiltration of the bone marrow by clumps of myeloma; and compression of the spinal cord.  Although it is useful for detecting new disease rapidly, there is a 9-month or more lag time before an MRI will look normal after an area of myeloma has been successfully treated and is no longer active.    It is an expensive study compared to x-ray, takes 30-60 minutes to complete, and covers a limited area of the body. 
  • CT or CAT Scan (Computerized Axial Tomography) uses x-ray technology to create a three-dimensional digital image of the body.  It is a much more precise study than x-ray, and can provide clear, detailed images of bone.  Downsides include expense, limited coverage of the body, and the need to use contrast agents that can pose problems for myeloma patients with kidney dysfunction.
  • PET Scan (Positron-Emission Tomography) requires that a patient be injected with a sugar-fluorine compound (FDG, or fluoro-deoxyglucose) that is taken up by the body's actively multiplying cells.  When the body is scanned, the areas with the highest concentrations of fluorine "glow," revealing "hot spots" where rapid metabolism can indicate areas of cancer cells.  This scan covers the whole body, is very sensitive in detecting potential tumor activity, and is the only "real-time" imaging study.  It is a valuable tool for patients who do not secrete monoclonal protein and whose myeloma is therefore difficult to assess, and for situations where x-ray, MRI, and CT do not provide enough information about potential new disease.  It is, however, expensive and time-consuming, requiring 90-150 minutes to perform.
  • PET/CT combines PET and CT scans in one imaging study, providing information both about past damage and current cancer activity, thus enabling the doctor to study changes over time.  It is a highly accurate study, but like standard PET, it is expensive and time-consuming.
Mike Katz, IMF Board Member

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Bone Disease in Multiple Myeloma
Dr. Brian Durie
Washington, DC 2009 Patient & Family Seminar
August 7-8, 2009

International Myeloma Working Group Guidelines on Imaging Techniques in the Diagnosis and Monitoring of Multiple Myeloma1
These guidelines represent a capsule summary, capturing the main points of, but not intended to replace the publication (listed to the right) from which they came.
International Myeloma Working Group Consensus Statement and Guidelines Regarding the Current Role of Imaging Techniques in the Diagnosis and Monitoring of Multiple Myeloma
Published in Leukemia (2009), 1–12