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Multiple Myeloma Prognosis: Survival Rates, Light Chain, and More Factors

Medically reviewed by Leonora Valdez, M.D.
Written by Maureen McNulty
Updated on February 23, 2024

If your doctor diagnoses you with multiple myeloma, they may also estimate your prognosis. Your prognosis, or outlook, describes how likely it is that your myeloma will progress (get worse). Doctors may use prognosis to help determine a treatment plan.

Read on to learn more about the factors that may go into your doctor’s evaluation of your multiple myeloma prognosis.

Multiple Myeloma Survival Rates

The five-year relative survival rate for multiple myeloma in the United States is 59.8 percent. This means that about 60 out of 100 people will be alive five years after being diagnosed with myeloma.

People diagnosed with very early-stage myeloma have better survival rates. About 4 percent of people are diagnosed when their myeloma is localized to one small area. This may be called a solitary plasmacytoma (plasma cell tumor). Around 79.5 percent of people diagnosed with localized myeloma live for at least five years after diagnosis, according to the National Cancer Institute.

For people whose myeloma has spread to distant sites beyond where it first developed, the five-year relative survival rate is 59 percent.

The five-year survival rate for myeloma has improved in the past few decades. Current rates don’t reflect improvements from the newest treatments.

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Survival Rates Are Improving

The five-year survival rate for myeloma has improved in the past few decades. From 1975 to 2005, myeloma survival rates improved about 2 percent every two years. Since 2005, survival rates have increased even more rapidly.

The discovery of new types of treatments has boosted survival rates within the past couple of decades. The U.S. Food and Drug Administration (FDA) approved several new drugs for myeloma in recent years, and progress is continuing: In 2023, the FDA approved two additional drugs and regimens.

Current five-year relative survival rates were calculated using data from people diagnosed between 2013 and 2019. These survival rates don’t take into account all the newest treatment options. People diagnosed with myeloma today may have a better prognosis, thanks to the benefits of current treatment options.

Prognostic Factors

Survival rates are estimated using large groups of people. They don’t tell you what your individual outlook will be. Your health care team can help you better understand your predicted outcome using prognostic factors — factors that are linked with a better or worse outcome. Several prognostic factors can tell you more about your outlook.

Age

Older adults with multiple myeloma tend to have a worse prognosis than do younger adults. The five-year relative survival rate by age group is:

  • Under age 50 — 92.7 percent for localized myeloma, 76.2 percent for those with distant spread
  • Ages 50 to 64 — 85.4 percent for localized myeloma, 68.7 percent for those with distant spread
  • Age 65 and older — 69.2 percent for localized myeloma, 51.1 percent for those with distant spread

Performance Status

Doctors use the term “performance status” to describe a person’s overall well-being. Karnofsky Performance Status Scale and ECOG (which stands for Eastern Cooperative Oncology Group) Scale of Performance are two performance scales, designed to measure how well a person functions.

Remission

When myeloma goes away after treatment, this is known as remission. A person may experience partial remission — cancer improves but doesn’t completely go away — or complete remission, when all cancer signs disappear. A complete remission does not mean that the disease may not return. If myeloma quickly goes into complete remission following treatment, a positive long-term outcome is more likely.

Blood Tests

Certain molecules in the blood can be signs of inflammation, damage, or cancer. Having high blood levels of any of the following is linked to a worse prognosis:

  • Beta-2 microglobulin
  • Lactate dehydrogenase (LDH)
  • Creatinine

The results of blood tests and cancer cell genetic tests may give doctors more insight into your prognosis.

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On the other hand, having a high albumin protein level in the blood is a sign of a better outcome.

Gene or Chromosome Changes

Doctors may test multiple myeloma cells to identify any changes to their chromosomes (long pieces of DNA that contain genes). Certain chromosome changes increase a person’s chances of having a poor outcome:

  • Deletion of all or part of chromosome 13
  • Deletion of part of chromosome 17
  • Amplification (copy) of part of chromosome 1
  • Chromosome translocations (part of one chromosome breaks off and abnormally attaches to another) between chromosome 14 and another chromosome

Researchers have also performed studies looking at how individual genes affect prognosis. Certain sets of genes can be found in cells at low or high levels, leading to a worse outlook.

Myeloma Stage

Myeloma prognosis is closely linked to myeloma stage. The stage describes how advanced the myeloma is and helps predict outcomes. People with higher stages of multiple myeloma have a poor prognosis.

Two systems are often used to stage multiple myeloma. The Durie-Salmon Staging System determines stage based on:

  • Levels of hemoglobin, used to measure anemia (low levels of red blood cells)
  • Calcium levels
  • Bone lesions (tumors)
  • Amount of monoclonal protein or M protein (an abnormal protein made by abnormal plasma cells)
  • Kidney function (how well the kidney is working)

A newer system, the Revised International Staging System, relies on gene changes and levels of beta-2 microglobulin, albumin, and LDH.

Plasma Cell Labeling Index

People who have faster-growing myeloma cells have a higher chance of having a poor outlook. A test called the plasma cell labeling index (PCLI) measures how quickly myeloma cells divide. A higher PCLI score means that cancer cells are growing faster.

Serum Free Light Chain

Cancerous plasma cells make abnormal immunoglobulins (antibodies). Each immunoglobulin is made up of two heavy chain proteins and two light chain proteins. Cancerous plasma cells often make more light chains than are needed for making antibodies. Extra light chain proteins can be measured with a test called a serum free light chain (SFLC) assay.

People with a high SFLC score are likely to have a poor prognosis. SFLC can also be used to predict prognosis in people who have milder forms of plasma cell disorders, such as monoclonal gammopathy of undetermined significance and smoldering myeloma. People with these conditions are more likely to develop multiple myeloma if they have a high SFLC.

Number of Abnormal Plasma Cells

Those who have higher numbers of abnormal plasma cells in their bone marrow are likely to have a worse disease course.

Neighborhood

In one study, researchers found that people who lived in lower-income neighborhoods had a higher chance of having a poor outcome.

Being Treated by a Specialist

As many as 80 percent of people with myeloma are diagnosed in community hospitals. However, people who are treated in community hospitals have worse outcomes. Prognoses are better for people treated in academic hospitals or in places that are a part of a network of cancer facilities.

Treatment Plan

Certain multiple myeloma treatments have a higher chance of success. People who have an autologous stem cell transplant — which uses a person’s own stem cells — are likely to have a better prognosis. However, stem cell transplants can lead to serious side effects and typically only buy time. Myeloma usually comes back in a few years. Allogeneic stem cell transplants — which use stem cells from a donor — can also be used, but they have more potential side effects. Stem cell transplantation may not be an option for people who are older or in worse health. Chimeric antigen receptor T-cell therapy is approved in the United States for relapsed or refractory myeloma.

Some multiple myeloma treatments have a higher chance of being effective. Talk to your doctor to make sure you understand all your treatment options.

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Other treatments also improve prognosis. Traditionally, people with multiple myeloma received chemotherapy as a first-line treatment. Recent studies have found that using newer medications as a first-line treatment for multiple myeloma leads to better outcomes.

Talk With Others Who Understand

MyMyelomaTeam is the social network for people with multiple myeloma and their loved ones. On MyMyelomaTeam, more than 23,000 members come together to ask questions, give advice, and share their stories with others who understand life with multiple myeloma.

Are you living with multiple myeloma? Have you and your doctor discussed the factors behind your prognosis? Share your experiences in the comments below, or start a conversation by posting on your Activities page.

References
  1. Cancer Stat Facts: Myeloma — National Cancer Institute Surveillance, Epidemiology, and End Results Program
  2. Multiple Myeloma: Statistics — Cancer.Net
  3. Clinical Pathways Updates in Multiple Myeloma: New and Expected Treatments for Refractory and Resistant Multiple Myeloma — Journal of Clinical Pathways
  4. A Historical Perspective on Milestones in Multiple Myeloma Research — European Journal of Haematology
  5. Oncology (Cancer)/Hematologic Malignancies Approval Notifications — U.S. Food and Drug Administration
  6. Myeloma — SEER 5-Year Relative Survival Rates, 2013-2019 — National Cancer Institute Surveillance, Epidemiology, and End Results Program
  7. Survival for Myeloma — Cancer Research UK
  8. Partial Remission — National Cancer Institute
  9. Complete Remission — National Cancer Institute
  10. Prognosis and Survival for Multiple Myeloma — Canadian Cancer Society
  11. The Evolution of Prognostic Factors in Multiple Myeloma — Advances in Hematology
  12. Myeloma Staging — Leukemia & Lymphoma Society
  13. Multiple Myeloma Stages — American Cancer Society
  14. Free Light Chains — MedlinePlus
  15. Analysis of Clinical Characteristics and Prognostic Factors of Multiple Myeloma: A Retrospective Single-Center Study of 787 Cases — Hematology
  16. The Prognostic Factors for Early Fatal Outcome in Patients With Multiple Myeloma — Blood
  17. Why All Multiple Myeloma Patients Need a Myeloma Specialist — HealthTree Foundation
  18. Clinical Outcomes and Prognostic Factors in Patients With Multiple Myeloma in South Tyrol: A Retrospective Single-Center Analysis — Annals of Hematology

Updated on February 23, 2024
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Leonora Valdez, M.D. received her medical degree from the Autonomous University of Guadalajara before pursuing a fellowship in internal medicine and subsequently in medical oncology at the National Cancer Institute. Learn more about her here.
Maureen McNulty studied molecular genetics and English at Ohio State University. Learn more about her here.

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