Myeloma is an uncontrolled growth of the plasma cells, a type of WBC that produces antibodies and maintains the immunity factor of a human body. This uncontrolled growth occurs in the bone marrow, gets circulated throughout the body and damages the healthy blood cells. The causality for myeloma is still unknown but it could develop due to environmental stress like exposure to radiations, genetic abnormalities like c-Myc oncogenes, family history or other problems related to MGUS (monoclonal gammopathy of undetermined significance).

Physicians determine the presence of myeloma through routine blood tests that reflect abnormal amounts of protein in the blood or coagulation of the red blood cells stacked up like coins in a pattern called Rouleaux. The most common and assertive technique the present-day medical science uses is defined as CRAB, where physicians will look out for

• High levels of C alcium
• R enal failure
• A nemia
• B one degeneration which may include lytic lesions, osteoporosis

The above is then backed with imaging devices like CT scan, MRI, bone marrow biopsy, bone marrow aspiration, serum-free light chain assay, and FISH test.

Based on the factors and diagnosis, MM is segregated into different stages. Staging helps doctors to identify the extent of the disease, predict its progression and develop a treatment plan.

The two main systems used to stage multiple myeloma are:

The Durie-salmon system
It is a traditional approach that has now been overtaken by a much convenient and reliable approach i.e., ISS.

This system has three stages, each system is further classified into A or B, depending on the extent of kidney function affected. B classification refers to significant kidney damage.

Stage I:
At this stage the myeloma usually does not show any symptoms, patients have a lesser number of cancer cells. This stage of multiple myeloma is characterized by the following.

• Hemoglobin concentration within the normal range > 10.5g/dL
• Calcium levels are at the borderline of normal or ≤ to 12mg/dL
• Normal bone structure, no lesions or maybe only 1
• Low levels of M-protein in blood and urine: M protein < 5 g/dL for IgG; < 3 g/dL for IgA; < 4 g/24 h for urinary light chain

Stage II
This stage of multiple myeloma has an increased number of cancer cells. Patients at Stage II level are neither fit for Stage I or Stage III.

Stage III
At this stage of multiple myeloma, the treatment that is advised is chemotherapy, radiotherapy, immunotherapy, or a combination of these treatments. this stage of multiple myeloma is characterized by the following.

• Alert the number of cancerous cells in the bloodstream.
• Decrease in blood count < 8.5 g/dL leading to Anemia
• Hypercalcemia
• Advanced bone damage
• High levels of M-protein in blood and urine: M protein > 7 g/dL for IgG; > 5 g/dL for IgA; > 12 g/24 h for urinary light chain

The International Staging System is based on the measurement of serum albumin, serum β2-M and lactate dehydrogenase (LDH). These are again of three stages:

Stage I:

• β2-M level < 3.5mg/L
• Serum albumin level of 3.5g/dL or more
• Normal LDH
• Low-risk cytogenetics

Stage II

• β2-M level between 3.5mg/L and 5.5 mg/dL
• Serum albumin level < 3.5g/dL
• Normal LDH
• Low-risk cytogenetics

Stage III

• β2-M level more than 5.5 mg/L
• High level of LDH
• High-risk cytogenetics

After staging, the physician then determines the level and course of treatment. Usually a combination of chemotherapy, targeted drugs and steroids is prescribed.

Though measures to curb the disease are in process and progress, this dysfunction is not considered “curable”, there could be long periods of dormancy but there are high chances of relapse.