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.
The five-year survival rate for multiple myeloma in the United States is 55.6 percent. This means that around 55 out of 100 people will live for five years or more 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 77.5 percent of people diagnosed with solitary plasmacytoma live for at least five years after diagnosis.
The five-year survival rate for myeloma has improved in the past few decades. From 1975 to 2005, myeloma survival rates improved by 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) has approved several new drugs for myeloma in recent years. Progress is continuing. In 2020, the FDA approved three new myeloma drugs and several new regimens (combinations of medications). Thus far in 2021, the FDA has approved additional drugs and regimens, including a new type of cancer treatment that involves genetically engineering immune cells.
Current five-year survival rates were calculated using data from people diagnosed from 2011 to 2017. These survival rates don’t take into account the newest treatment options. People diagnosed with myeloma today may have a better prognosis than current data suggests.
Survival rates are estimated based on the outcomes of 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.
Older adults with multiple myeloma tend to have worse prognosis than do younger adults:
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. People who are better able to complete daily tasks and are more active are likely to have a positive prognosis.
When myeloma goes away after treatment, it is known as remission. A person may experience partial remission — when 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.
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:
On the other hand, having a high level of albumin protein in the blood is a sign of a better outcome.
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:
Researchers have also performed studies looking at how individual genes impact prognosis. Certain sets of genes can be found in cells at low or high levels, leading to a worse outlook.
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.
A newer system, the Revised International Staging System, relies on gene changes and levels of beta-2 microglobulin, albumin, and LDH.
People who have faster-growing myeloma cells have a higher chance of having a poor outlook. A test called a plasma cell labeling index (PCLI) measures how fast myeloma cells divide. A higher PCLI score means that cancer cells are growing faster.
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 (or MGUS) and smoldering myeloma. People with these conditions are more likely to develop multiple myeloma if they have a high SFLC.
Those who have higher numbers of abnormal plasma cells in their bone marrow are likely to have a worse disease course.
In one study, researchers found that people who lived in lower-income neighborhoods had a higher chance of having a poor outcome.
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.
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 the 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 is often not an option for people who are older or are in worse health. Chimeric antigen receptor T-cell therapy (or CAR-T cell therapy) is approved in the United States for relapsed or refractory myeloma.
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 leads to better outcomes.
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