Multiple Myeloma Stages and Prognosis

Medically Reviewed by Melinda Ratini, MS, DO on May 27, 2023
4 min read

What is a stage? When you're first diagnosed with multiple myeloma, your doctor will assign it a number, called a stage, that describes how serious it is at that point. That number has a lot to do with the type of treatment your doctor will recommend and what you can expect from your disease going forward.

There's no cure for multiple myeloma, but treatment can bring it into remission, meaning you don't have any sign of the disease.

The same tests your doctor uses to know if you have multiple myeloma will also help them tell what stage it's in. They include:

  • Blood tests
  • Urine tests
  • Bone marrow tests
  • X-rays and other imaging tests
  • Genetic tests of the cancer cells

There are two systems that identify the stages of multiple myeloma. The newer one, which doctors use most often, is the revised international staging system (RISS). It predicts how well you'll do with treatment. It measures four things to figure out how aggressive your cancer is:

  • Albumin levels. This protein in your blood shows how healthy you are overall.
  • Beta-2 microglobulin (B2M). Levels of this protein in your blood are high when you have multiple myeloma.
  • Lactate dehydrogenase (LDH). This enzyme can be high if your disease is more advanced.
  • Genetic changes to your cancer cells mean your myeloma is more aggressive.

Stage I

  • Your levels of albumin, B2M, and LDH are normal or close to it.
  • The genetic makeup of your cancer cells doesn't make it particularly aggressive.
  • Multiple myeloma is most treatable at this stage, but most people don't know they have it until it's more advanced.

Stage II

  • Your albumin level is low.
  • Your B2M is either still normal or a bit high.

Stage III

  • Your B2M levels are high, which shows the disease is widespread and advanced.
  • You have either a high LDH level or risky changes in your cells' DNA.

You might hear your doctor talk about it. It isn't a staging system, but a method doctors used for determining if you had specific symptoms. It isn't used as much as it used to be because multiple myeloma is getting diagnosed at earlier stages.

Some people have multiple myeloma for months or years before they even know they're sick. This earliest phase is called smoldering multiple myeloma. When you have it, you won't have any symptoms, but your test results will show:

At least 10% to 59% of your bone marrow is made up of cancerous plasma cells.

  • You have the abnormal antibodies that myeloma cells make in your blood or urine.

It's rare to be diagnosed with smoldering multiple myeloma. Many people only find out they have it because a blood test they took for another reason showed unusual protein levels.

If you're having symptoms, or there are signs that the cancer has damaged your organs, you have active myeloma. Tests will show the presence of a plasma cell tumor or cancer cells that make up at least 10% of your bone marrow and at least one of these other signs:

  • The balance of certain proteins in your blood is way off.
  • A high level of calcium in your blood
  • Kidney damage
  • A low number of red blood cells, called anemia
  • Bone damage
  • Your bone marrow is 60% cancerous plasma cells or more.

As active multiple myeloma gets worse, you'll likely feel sicker, with fatigue or bone pain. You may have anemia, bleeding problems, or a lot of infections. Other symptoms of advanced multiple myeloma include unusual fractures, shortness of breath, weakness, feeling very thirsty, and belly pain.

Refractory myeloma is when your disease doesn't respond to treatment or comes back after treatment. There are two types:

  • Relapsed and refractory myeloma. This is a relapse of disease when you've had some response to treatment, then either get non-responsive while on salvage therapy (treatment given when standard treatment doesn't work) or progress within 60 days of your last treatment.
  • Primary refractory myeloma. You don't respond to any treatment. There are two sub-categories:
    • You don't respond to treatment but your disease doesn't progress.
    • You have primary refractory disease that is progressing.

Relapsed myeloma. After a while without treatment you need salvage therapy but do not meet criteria for "primary refractory" or "relapsed and refractory" categories.

Remember, no two people are entirely alike. Treatment and responses to treatment can vary greatly.

In general, 50.7%, or about half the people diagnosed with multiple myeloma were alive 5 years later. That's because it's often difficult to diagnose multiple myeloma until it's progressed. But the earlier you catch it, the better your chances are.

  • Early-stage diagnosis. For the 5% of people who are diagnosed at an early stage, the 5-year survival rate is 71%.
  • Later-stage diagnosis. If the cancer has spread to a distant part of the body, the 5-year survival rate is 48%.

The stage of your multiple myeloma is just one thing that predicts how much treatment will help you. Other things that make a difference include:

  • Age. The younger you are, the longer you're likely to live.
  • General health. Other problems like diabetes or heart disease make it harder for treatment to succeed.
  • Kidney health. You're likely to do better if you get your diagnosis before the disease damages your kidneys.

Doctors are doing a lot of research on treatments for multiple myeloma, and these medicines have gotten better in recent years. So there are reasons to be hopeful about your outlook.