Multiple Myeloma Stages and Prognosis

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 him 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

Staging Systems for Multiple Myeloma

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.
  • According to one study, more than half of those diagnosed with multiple myeloma in stage II live 7 years or more past the start of treatment.

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.
  • More than half of people diagnosed in stage III live at least another 3 1/2 years.

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Durie-Salmon Staging System

This system was created many years ago. It measures how much cancer you have and what it’s doing to your body based on:

  • The level of abnormal proteins in your blood or urine
  • The amount of hemoglobin you have, which shows whether your body is making enough healthy blood cells
  • The level of calcium in your blood, which shows whether multiple myeloma is damaging your bones
  • The amount of bone damage
  • How well your kidneys are working

Staging Systems for Multiple Myeloma

This system was created many years ago. It measures how much cancer you have and what it’s doing to your body based on:

  • The level of abnormal proteins in your blood or urine
  • The amount of hemoglobin you have, which shows whether your body is making enough healthy blood cells
  • The level of calcium in your blood, which shows whether multiple myeloma is damaging your bones
  • the amount of bone damage
  • How well your kidneys are working

Stage I

  • Your hemoglobin and calcium levels are about normal.
  • X-rays show no bone damage and no more than one bone marrow tumor.
  • You have abnormal proteins in your blood and urine, but not at high levels.

Stage II

  • Your hemoglobin, calcium, and abnormal proteins levels are between those for stage I and stage III.
  • You may or may not have signs of kidney damage.

Stage III

  • You have low levels of hemoglobin and a high amount of calcium in your blood.
  • X-rays show more than three areas of damaged bone.
  • You have high levels of abnormal proteins.

What Is CRAB?

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.

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Smoldering Multiple Myeloma

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

Between 10% and 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.

Active Multiple Myeloma

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, weakness, feeling very thirsty, and belly pain.

Recurrent or Relapsed and Refractory Multiple Myeloma

Refractory melanoma 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.

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Life Expectancy

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%.

Things That Affect Your Outlook

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.

WebMD Medical Reference Reviewed by Laura J. Martin, MD on October 1, 2018

Sources

SOURCES:

American Cancer Society: “Multiple Myeloma Stages,” “What Is Multiple Myeloma?” “Can Multiple Myeloma Be Found Early?” “Signs and Symptoms of Multiple Myeloma,” “Survival Rates by Stage for Multiple Myeloma.”

National Cancer Institute: “Plasma Cell Neoplasms (Including Multiple Myeloma) Treatment (PDQ)-Health Professional Version,” “Plasma Cell Neoplasms (Including Multiple Myeloma) Treatment (PDQ)-Patient Version,” “NCI Dictionary of Cancer Terms.”

Leukemia and Lymphoma Society: “Myeloma,” “Myeloma Signs and Symptoms,” “Myeloma Staging,” “Myeloma Diagnosis.”

Bloodwise: “Myeloma treatment and side effects,” “What is myeloma?” “Myeloma symptoms and diagnosis.”

National Comprehensive Cancer Network: “NCCN Guidelines for Patients: Multiple Myeloma.”

Multiple Myeloma Research Foundation: “What is Multiple Myeloma?” “Prognosis.”

Blood: “Smoldering multiple myeloma.”

American Society of Clinical Oncology: “Multiple Myeloma: Stages,” “Multiple Myeloma: Symptoms,” “Multiple Myeloma: Statistics.”

Medline Plus: “Albumin Blood Test.”

Lab Tests Online: “Beta-2 Microglobulin Tumor Marker.”

University of Rochester Medical Center: “Lab Tests for Cancer.”

University of New Mexico: “Recurrent Multiple Myeloma.”

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