Multiple Myeloma Stages and Prognosis

Multiple myeloma is a form of cancer that develops in white blood cells, specifically, plasma cells. In 2020 alone, there were 32,270 new cases of multiple myeloma, making up 1.8% of all new cancer cases in the United States. The estimated deaths per year from multiple myeloma were 12,830, accounting for 2.1% of all cancer deaths. The five-year survival rate is 53.9%.

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

What Is Multiple Myeloma?

Plasma cells originate from bone marrow and are immune cells. They are designed to create antibodies to protect the body from infection. In multiple myeloma, a group of plasma cells becomes cancerous and multiplies. As a result, more and more antibodies are made, which can cause the blood to thicken and keep the bone marrow from making healthy blood cells. These plasma cells build up in the bone marrow and form tumors in many bones of the body.

Multiple myeloma is a type of blood cancer, not a solid tumor.

H&E stain, light microscopy, multiple myeloma

UCSF / Getty Images

Survival Rates

The percentage of people in a study or treatment group who are alive five years after they were diagnosed with or started treatment for a disease. These survival rates are estimates.

Survival rates vary significantly by stage of the disease. Those with serious cancers who are in stage 1, for example, may have better survival rates than those with stage 2 or 3 cancer.

The survival rates of multiple myeloma are estimated based on epidemiologic data collected by the National Cancer Institute’s SEER program, and the stages they use for multiple myeloma are different from the ones they use for solid tumor cancer.

Under the SEER program, multiple myeloma is classified by the number of tumors present, and are described as localized (one tumor), distant (many tumors throughout the body), and regional. Since multiple myeloma does not travel to the lymph nodes, the regional stage does not apply.

Five-year Survival Rate of Multiple Myeloma by Stage
 Stage  Percent of Cases by Stage Five-Year Survival Rate
Localized  5%  74.8%
Regional  0% Not applicable 
Distant  95%   52.9%
All stages combined  100%   52%

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 is a prediction of how it 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 stages of multiple myeloma as defined by the International Staging System are:

  • Stage 1: Only a small number of the cancer cells can be found, and they are in a localized area. The number of cancer cells is measured by the level of two specific proteins, albumin and beta-2-microglobulin. At this stage, the level of beta-2-microglobulin, which can help decode levels of tumor cells in blood, is less than 3.5 mg/L. Levels of albumin, a globular protein, are typically 35 g/L or more
  • Stage 2: More myeloma cells are found, while beta-2-microglobulin levels are less than 3.5 mg/L and albumin levels are less than 35 g/L. 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: A large number of myeloma cells is present, and 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. During what stage the disease is diagnosed also plays a role because earlier identification means someone can receive treatment earlier.

Symptoms

Symptoms of multiple myeloma, especially kidney failure, can lead to a lower chance of survival. In one study, 16% of multiple myeloma patients had renal impairment and their median overall survival of 13 months compared with 41 months in patients without this complication.

Lab Values

Several clinical and laboratory findings considered prognostic indicators can help determine how fast the tumor is growing, the extent of disease, the biological makeup of the tumor, the response to therapy, and the overall health status of the individual. Establishing the levels of these prognostic tests early provides a baseline against which disease progression and response to therapy can be measured.

Chromosomal Abnormalities

Another factor that affects prognosis is whether a person diagnosed with multiple myeloma has chromosomal abnormalities, specifically chromosomal 1 abnormalities. Patients with this abnormality experience lower survival rates than those without.

Several cytogenetic abnormalities signal poor prognosis because people with these abnormalities only benefit from 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:

  • Stringent complete response: Complete disappearance of tumor plasma cells
  • Complete response: Tumour plasma cells are still present but in significantly lower amounts.
  • Very good partial response: Serum protein is reduced by 90%
  • Partial response: This is a 50% reduction in serum proteins. The only way to determine the progression of the disease at this point is through new bone lesions
  • Minimal response: Classified as remission, there is a reduction in serum protein by 25% to 49%
  • Stable disease: This response is classified as unresponsive to treatments, and 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 obesity can increase a person's risk of multiple myeloma, but it is unclear whether altering these risk factors affects survival rate. Positive lifestyle changes, however, can help manage the symptoms of multiple myeloma such as fatigue, bone health, and kidney health.

Diet

Diet, specifically, can play a vital role in the management of multiple myeloma symptoms. Some foods have been found to have anti-cancer properties. These foods won't cure the disease but will aid the body in recovery. For example, foods high in ursolic acid can help reduce cancer cells because ursolic acid is cytotoxic. Foods such as apples, basil, rosemary, and cranberries also contain ursolic acid. Isothiocyanates, small molecules found in cruciferous vegetables, have also shown to promote anti-tumor activity within the body. Foods high in isothiocyanates include cabbage, broccoli, and Brussels sprouts.

Foods that have been shown to fight fatigue include eggs, bananas, and kale. These foods can help balance energy levels because they contain protein, fiber, and iron, respectively. Too much protein or potassium, however, can negatively impact the kidneys.

Eating foods low in sodium, phosphorous, and potassium such as buckwheat, blueberries, red grapes, olive oil, skinless chicken, and arugula will be a great help if a person experiences renal issues while battling multiple myeloma.

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

Exercise

Since exercise supports immune function, it's a good idea to incorporate as much exercise as possible for people with multiple myeloma. Exercise also improves renal function because it can improve vital metabolic factors, such as blood glucose, body weight, and plasma lipids.

Exercise can also improve fatigue levels because participating in cardiovascular activity has been shown to improve blood circulation. This leads to better dispersion of oxygen throughout the body, lessening overall fatigue levels. 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 eliminate any germs or bacteria someone may have come into contact with that could compromise their health further.

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 further infection could also help, but treatment and the stage of multiple myeloma may affect someone's eligibility for these vaccinations.

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 believe a fall may occur.

A Word From Verywell

Multiple myeloma may seem like a difficult type of cancer to overcome, but new advancements in treatment options continue to be developed and can potentially help improve overall prognosis and survival rate. The development of new 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.  

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