Multiple myeloma is a type of blood cancer that affects plasma cells. Doctors use a three-step staging system to classify the severity of multiple myeloma and whether it has spread.
A person may experience different types of symptoms in each stage, and survival rates will change depending on the stage of myeloma.
Plasma cells are a type of white blood cell that helps fight infections. In multiple myeloma, plasma cells become cancerous myeloma cells and outnumber healthy blood cells. This causes damage to the immune system, bones, and blood.
According to the
This article explains the different multiple myeloma stages and discusses the symptoms, treatment, and outlook for people with multiple myeloma.
These are the staging systems:
Revised International Staging System
Doctors use the Revised International Staging System (RISS) to determine the stage of multiple myeloma.
The RISS takes the following factors into account to determine the stage of myeloma:
- the level of albumin in the blood (a protein made by the liver)
- the level of beta-2-microglobulin in the blood (a protein found on the cell surface)
- the amount of lactate dehydrogenase (LDH) in the blood (an enzyme found in the cells)
- cytogenetics (specific gene abnormalities of cancer)
These stages are used to estimate a person’s outlook.
Surveillance, Epidemiology, and End Results Program
Instead, SEER classifications stage multiple myeloma based on whether it has spread through the body.
If the cancer is only found in the part of the body where it began, it is called localized.
If the cancer has spread to the lymph nodes, it is called regional.
If the cancer has spread to a secondary site in the body (metastatic cancer) it is called distant.
The following are the stages of RISS:
People with stage 1 multiple myeloma have early disease.
Tests for stage 1 multiple myeloma will show there are only a small number of myeloma cells in the blood.
A person may not show symptoms if they have stage 1 multiple myeloma.
Tests results for stage 1 will show:
- albumin level of 3.5 (g/dL) or greater
- beta-2-microglobulin 3.5 (mg/L) or less
- LDH level is normal
- cytogenetics are not considered high risk
According to SEER, a person with stage 1 multiple myeloma has a
Classification of stage 2 multiple myeloma occurs with test results that are between the levels expected for stage 1 and stage 3.
Stage 2 indicates the progression of the cancer.
Test results for stage 2 will show an albumin level of less than 3.5 g/dL and a beta-2-microglobulin between 3.5-5.5 mg/L.
A person with stage 2 multiple myeloma will have a lower chance of surviving for 5 years after diagnosis than a person with stage 1.
Stage 3 is the most advanced stage of multiple myeloma.
Stage 3 shows that there is a greater number of myeloma cells in the body.
A person with stage 3 multiple myeloma will continue to experience any symptoms they had in stage 2. They may also experience new symptoms, such as:
- frequent infections
- weight loss
Test results for stage 3 show:
- albumin levels of greater than 3.5 g/dL
- beta-2-microglobulin over 5.5 mg/L
- LDH is above normal levels
- cytogenetics are considered high risk
According to SEER, a person with stage 3 multiple myeloma has a
The Durie-Salmon System is another staging method used to classify the severity of multiple myeloma. It was developed in 1975 and aims to determine the amount of myeloma cells in the body and how much damage they have caused, such as bone disease or anemia.
The Durie-Salmon System is not as common as RISS staging.
The system involves staging multiple myeloma based on the following factors:
Multiple myeloma may progress over time. As the condition progresses, a person may experience an increase in symptoms. How quickly multiple myeloma progresses can vary between people.
An older 2007 study of 276 people found that there was a 10% risk of progression in people with early multiple myeloma per year for the first 5 years of illness. This decreased to 3% per year for the next 5 years, and again to 1% per year for the final 10 years. Overall, researchers found there was a 73% chance of progression over a 15-year period.
The risk factors for progression included how much the disease had affected the bone marrow and the levels of monoclonal protein in the blood at the time of diagnosis.
As multiple myeloma progresses, a person’s symptoms can go through a variety of changes.
For example, multiple myeloma interferes with proper red blood cell production. A decrease in blood cells may cause anemia, which may lead to shortness of breath and weakness.
Multiple myeloma can also weaken the bones. The NCI states this can lead to bone breaks or fractures. The bones in the spine may put pressure on the nerves in the spinal cord, which can cause numbness in the legs.
The NCI also lists kidney problems and a variety of other symptoms as signs of the disease, such as swollen ankles, weight loss, and nausea.
In some cases, a person with multiple myeloma may also develop a weakened immune system, which may increase their risk of infections.
Treatments for myeloma can also lead to side effects, such as loss of appetite, nausea, and fatigue.
The two main types of multiple myeloma include active and smoldering. Smoldering means a person has some myeloma cells but no symptoms of the disease. People with active multiple myeloma will experience symptoms.
The types of multiple myeloma are categorized based on the type of abnormal immunoglobulin (Ig) the myeloma cells are making. The type of abnormal immunoglobulin myeloma cells produce will vary from person to person.
The main subtypes of multiple myeloma include:
- Gamma (IgG)
- Alpha (IgA)
- Mu (IgM)
- Epsilon (IgE)
- Delta (IgD)
According to Cancer Research UK, IgG is the most common abnormal immunoglobulin to be produced in multiple myeloma. The next most common is IgA. IgM, IgD, and IgE are very rare.
Cancer Research UK also states that 3% of people with myeloma will have non secretory myeloma. This means that the myeloma cells make little to no immunoglobulin. This type of myeloma is harder to diagnose.
Conditions related to multiple myeloma include:
- Monoclonal gammopathy of undetermined significance (MGUS): This does not usually need treatment as it does not cause symptoms, but 1% of people with MGUS develop myeloma every year.
- Plasmacytoma: Tumors made up of plasma cells that group together. Over 50% of people with plasmacytoma will develop myeloma.
- Amyloidosis: A rare condition that causes plasma cells to produce amyloid protein and damages the kidneys or heart. 10-15% of people with myeloma develop amyloidosis.
A person’s outlook will be affected by their stage of multiple myeloma. However, other factors may also play a role.
For example, the levels of certain proteins in a person’s blood may affect their outlook.
The following factors may also affect a person’s outlook:
- kidney function
- overall health
People with smoldering multiple myeloma without symptoms usually do not require treatment. Once symptoms occur, treatment may include:
- Chemotherapy: Chemotherapy helps destroy cancer cells. Chemotherapy also may damage normal cells, which can cause hair loss, nausea, and fatigue.
- Steroids: Steroids help treat side effects from chemotherapy medications, such as nausea and vomiting.
- Proteasome inhibitors: This class of medications works by preventing specific enzymes in the cells from breaking down proteins. Proteasome inhibitors help control cell division.
- Monoclonal antibodies: This treatment involves administering man-made antibodies that destroy proteins on the surface of myeloma cells.
- Stem cell transplant: A stem cell transplant involves receiving high-dose chemotherapy, which kills cancer cells in the bone marrow. After chemotherapy, the individual receives new stem cells from a donor or their own banked stem cells.
In addition to treatment, the American Cancer Society recommends that a person is monitored by medical professionals to help them cope with their illness.
Careful monitoring by a healthcare professional can help identify disease progression. Identifying the stage of the disease helps target the most appropriate treatment.
Healthy lifestyle habits, such as not smoking, eating a well-balanced diet, getting enough sleep, and exercise can help a person manage symptoms of myeloma, as well as cope with side effects of treatment, the ACA says.
People with multiple myeloma may also want to find ways to help manage pain caused by multiple myeloma. Pain management can include pain relieving medication, radiation therapy, massage, or acupuncture.
Multiple myeloma is a type of cancer that affects the plasma cells in the blood. It can lead to a variety of symptoms, such as fatigue, bone pain, and frequent infections. There are treatments to improve the symptoms of multiple myeloma, but there is no cure.
Doctors stage the progression of the disease based on the results of laboratory tests. Stage 1 indicates early multiple myeloma that does not cause symptoms, stage 2 shows intermediate disease and may cause symptoms, and stage 3 is the most advanced stage of multiple myeloma, which means the cancer has spread to other parts of the body.
A person’s outlook and survival rate will be determined by the stage of the disease as well as their age, kidney function, and overall health.