Multiple Myeloma Stages and Prognosis

In 2020, there were 32,270 new cases of multiple myeloma, making up 1.8% of all new cancer cases in the United States. The five-year survival rate is 53.9%. and there are 12,830 estimated deaths per year from multiple myeloma, accounting for 2.1% of all cancer deaths.

Many factors can affect survival rates, such as age and overall health. The survival rate of multiple myeloma has almost doubled since 1975.

Survival Rates

Survival rates vary significantly by stage of the disease. If you are diagnosed and treated in stage 1, for example, you have a better survival rate than you would if you were diagnosed with stage 2 or 3 multiple myeloma.

The survival rates of multiple myeloma are estimated based on epidemiologic data collected by the National Cancer Institute’s SEER program. Multiple myeloma is classified by the number of tumors present and is described as localized (one tumor) or distant (many tumors throughout the body).

These survival rates don’t take personal risk factors into account. For example, if a person with distant multiple myeloma takes care of their health in every aspect, their likelihood of survival could be better than someone who has the same condition but does not lead a healthy lifestyle.

Factors That Influence Survival

Prognosis of multiple myeloma is a prediction of how the condition will develop and change over time. Several factors that are not reflected in the SEER data can influence an individual's prognosis, including stage of the disease.

Stage of Disease

The stage of multiple myeloma is determined by the level of two specific proteins—albumin and beta-2-microglobulin. Albumin is a component of healthy blood and beta-2-microglobulin is elevated in blood cancer.

The stages of multiple myeloma as defined by the International Staging System are:

• Stage 1: At this stage, the level of beta-2-microglobulin is less than 3.5 milligrams (mg)/liter (L). Levels of albumin are typically 3.5 grams (g)/deciliter (dL) or more.
• Stage 2: The beta-2-microglobulin is less than 3.5 mg/L, and the albumin is less than 3.2 g/dL. This stage can also be characterized by beta-2-microglobulin levels that are more than 3.5 mg/L and less than 5.5. mg/L with any level of albumin.
• Stage 3: Beta-2-microglobulin levels are 5.5. mg/L or higher with any level of albumin

Age

Age also affects survival. Young people with this condition are more likely to have a better prognosis.

Symptoms

Certain effects of multiple myeloma, especially kidney failure, can lead to a lower chance of survival. In one study, 16% of multiple myeloma patients who had renal impairment had a median overall survival of 13 months, compared with a median 41-month survival for patients without this complication.

Lab Values

Clinical and laboratory findings can help determine how fast the tumor is growing, the extent of the disease, the biological makeup of the tumor, and the response to therapy. Establishing the levels of these prognostic tests early in the course of treatment provides a baseline against which disease progression and response to therapy can be measured.

Chromosomal Abnormalities

Abnormalities associated with multiple myeloma have been identified in chromosomes 14 and chromosome 17. Patients with these abnormalities tend to experience lower survival rates than those without.

Several genetic abnormalities also reflect responsiveness to treatments and can be used to help direct specific forms of treatment.

Gene Expression

Researchers have found multiple myeloma disease genes using gene expression profiling, which has led to the development of a gene-based classification system for multiple myeloma. One study found a total of 156 genes, including FGFR3 and CCND1, exhibited highly elevated expression in multiple myeloma cases.

Treatment Response and Recurrence

A person’s survival rate can also be affected by how well they respond to treatment. Responses are measured by levels of monoclonal proteins found in blood serum or urine. They are classified as follows:

• Complete response: There is no evidence of abnormal plasma cells
• Very good partial response: Abnormal monoclonal protein is reduced by 90%
• Partial response: A 50% reduction in abnormal monoclonal protein
• Minimal response: A reduction in abnormal monoclonal protein by 25% to 49%
• Stable disease: There is no change in the disease following the course of treatment
• Progressive disease: Cancer continues to progress during or after treatment

Even following successful treatment, multiple myeloma has a high recurrence rate. Many second-line therapies for multiple myeloma can positively influence survival rates for these cases. The second-line treatment combination of lenalidomide-dexamethasone resulted in a 37% reduction in death or further progression of the disease in one study.

What You Can Do

Certain lifestyle factors, like diet and exercise, can increase a person's risk of multiple myeloma, but it is unclear whether altering these risk factors affects the survival rate. Positive lifestyle changes, however, can help manage some symptoms of multiple myeloma, such as fatigue, bone health, and kidney health.

Diet

Foods high in calcium can help maintain bone health, including dairy products, green leafy vegetables, nuts, and fish with edible bones.

Too much protein or potassium can negatively impact the kidneys if your kidneys have been affected by multiple myeloma.

Getting an ample amount of fresh fruit and vegetables and avoiding processed food can help keep you healthy, preventing the burden of inflammation on your body.

Exercise

Since exercise supports immune function and helps prevent fatigue, it's a good idea to incorporate moderate exercise into your life. Exercise also improves renal function because it can improve vital metabolic factors, such as blood glucose, body weight, and plasma lipids.

People with multiple myeloma can choose low-intensity workouts such as brisk walking, light jogs, or low-resistance biking.

Bone health can also be affected positively by regular exercise—but the right intensity, duration, and considerations for possible bone lesion locations will need to be taken into account prior to starting an exercise program while being treated for multiple myeloma.

Reduce Infection Risks

Since patients with multiple myeloma have a weakened immune system, it's important to mitigate the risk of infection. Washing hands frequently and often will help reduce germs, such as viruses and bacteria.

Staying away from crowds, using hand sanitizer when you are unable to wash your hands, and avoiding touching your face whenever possible can also help.

Flu or pneumonia vaccines may also help reduce the risk of infection. Your treatment and disease, however, may affect your eligibility for live vaccines.

Avoid Falls

Since multiple myeloma weakens bones, it's important to prevent injuries such as falls. Avoid falls wherever possible by knowing your limitations, using assistive devices where necessary, and install handrails in areas of the home where you may have a fall risk.

A Word From Verywell

A diagnosis of multiple myeloma can feel overwhelming, but new advancements in treatments can potentially help improve overall prognosis and survival. The development of proteasome inhibitors such as Velcade (bortezomib), Kryprolis (carfilzomib), and Ninlaro (ixazominb) have shown great promise in both increasing the rate of survival and improving outcomes for those with this condition. With the right treatment and lifestyle changes, you can minimize the impact this disease has on your longevity.