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Stage 1 Multiple Myeloma: What To Expect

Posted on July 08, 2021
Medically reviewed by
Mark Levin, M.D.
Article written by
Maureen McNulty

Multiple myeloma develops when a type of white blood cell called a plasma cell undergoes changes and starts growing out of control. Plasma cells are a part of the immune system. They make antibodies to help fight infection.

Doctors assign each case of multiple myeloma a stage. The stages of multiple myeloma tell you how advanced the cancer is and how much it has spread within the body. Doctors use staging information to guide treatment decisions and to estimate a person’s outlook.

What Is Stage 1 Multiple Myeloma?

Stage 1 (or stage I) multiple myeloma is the least advanced stage. People with stage 1 myeloma have few myeloma cells in the body. The cancer cells have not yet spread very far or caused as much damage as in other stages.

There are two main staging systems that doctors may use to determine myeloma stage: the International Staging System (ISS) and the Durie-Salmon Staging System. These systems measure stages in slightly different ways, based on the results of different blood, urine, or genetic tests.

International Staging System

When staging myeloma, doctors most often use the International Staging System (ISS) or its updated version, the Revised ISS (R-ISS). The R-ISS takes into account levels of three proteins found in the blood: albumin, beta-2 microglobulin, and lactate dehydrogenase (LDH). Lower levels of albumin and higher levels of beta-2 microglobulin and LDH indicate that myeloma is becoming more advanced. The R-ISS is also based on cytogenetics — gene changes found within the myeloma cells.

Using the R-ISS, stage 1 multiple myeloma has the following features:

  • High levels of albumin (3.5 grams per deciliter or higher)
  • Low levels of beta-2 microglobulin (less than 3.5 milligrams per liter)
  • Normal levels of LDH
  • No high-risk gene changes

Durie-Salmon Staging System

Some doctors use an older method of staging myeloma, called the Durie-Salmon Staging System. Doctors are using this system less often in favor of the ISS.

Based on the Durie-Salmon system, people with stage 1 multiple myeloma have:

  • High levels of hemoglobin in the blood (more than 10 grams per deciliter)
  • Normal calcium levels in the blood
  • Low blood levels of monoclonal protein (M protein), an abnormal antibody
  • Low urine levels of light-chain proteins (abnormal fragments of antibodies)
  • No more than one plasmacytoma (a bone tumor)

If you have any questions about your multiple myeloma stage, ask your doctor to explain what your test results mean and how your stage is measured. You can also ask how your myeloma stage affects treatment options and outlook.

Related Conditions

Multiple myeloma is related to several other plasma cell disorders, including monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM). These disorders can lead to multiple myeloma and are sometimes called precursor stages. However, MGUS and SMM are not the same as the stages of active multiple myeloma. Even stage 1 myeloma is more advanced than MGUS and SMM.

MGUS is a mild disorder in which plasma cells behave abnormally but are not cancerous. People with MGUS may have slightly higher levels of plasma cells that make small amounts of M protein. The M protein is the only thing that shows up abnormal in tests. Some people with MGUS develop SMM, an asymptomatic form of myeloma characterized by higher levels of plasma cells and M protein. SMM is more severe than MGUS but less severe than active multiple myeloma. People with SMM don’t have certain signs that are necessary for the diagnosis of active multiple myeloma.

MGUS, SMM, and active multiple myeloma can occur one after the other, so doctors sometimes say that MGUS and SMM are early, precancerous “stages” or forms of multiple myeloma. However, the ISS and Durie-Salmon Staging Systems are used to describe the levels of active, cancerous multiple myeloma. They are not used to stage MGUS and SMM.

Signs and Symptoms of Stage 1 Multiple Myeloma

Some people with early-stage myeloma do not have any symptoms. However, myeloma always leads to certain signs that appear on blood tests or imaging tests. (Symptoms are what a person experiences, such as headache or nausea. Signs are measurable and observable by someone else, such as a fever.) Sometimes, a doctor will detect signs of myeloma and make a diagnosis before noticeable symptoms appear. As myeloma advances in stage, it may be more likely to lead to signs and symptoms of myeloma, including:

  • Bone pain
  • Extreme tiredness
  • High levels of calcium in the blood
  • Anemia (low levels of red blood cells)
  • Poor kidney function
  • Bone lesions (abnormalities or bone damage)
  • Frequent infections

If you are experiencing bone pain or any other symptoms of multiple myeloma, talk to your doctor.

Stage 1 Multiple Myeloma Treatments

Doctors make treatment recommendations based on a person’s signs and symptoms, overall health, personal preferences, and the results of certain tests.

Earlier forms of multiple myeloma such as MGUS and SMM may not need treatment right away. Some people live with these conditions for many years without using any medication or undergoing any procedures. However, people with signs and symptoms, including most people with active multiple myeloma — even in stage 1 — need to start treatment.

Most forms of active multiple myeloma are treated in a similar way. People with myeloma generally receive a combination of multiple different drugs, including chemotherapies or monoclonal antibodies. Other options may include:

People with stage 1 myeloma may use less aggressive treatment options than those with stage 2 or stage 3 disease.

Many people with multiple myeloma also use supportive treatments. These are therapies that don’t aim to kill cancer cells. Rather, they improve myeloma signs and symptoms. Early-stage multiple myeloma may not cause as many symptoms or lead to as much damage, so people with stage 1 myeloma may be less likely to need these treatments. For example, people with stage 3 myeloma may use bisphosphonate drugs to treat bone pain and strengthen bones.

Outlook for Stage 1 Multiple Myeloma

Doctors often measure a person’s prognosis (outlook) using a combination of survival statistics and individual factors. The five-year relative survival rate for all stages of multiple myeloma combined is 54 percent. This means that people with all stages of multiple myeloma are a little more than half as likely to live for five years or more after being diagnosed, compared to people without myeloma.

The relative survival rate has steadily increased over the past few decades, as researchers have learned more about myeloma and developed better treatments. This means that people diagnosed with multiple myeloma today may have better outcomes than current data may indicate.

Doctors use the R-ISS for determining prognosis in addition to staging. People with lower levels of albumin, or higher levels of beta-2 microglobulin or LDH, have a worse outlook. Survival statistics vary between people with different R-ISS stages:

  • About 82 percent of people with stage 1 disease live for five years or more after being diagnosed.
  • Approximately 62 percent of people with stage 2 disease live at least five years after diagnosis.
  • About 40 percent of people with stage 3 disease live for five years or more.

Other factors can also affect prognosis. People who have kidney problems, are older, or have other health conditions often have worse survival rates. If you are interested in learning more about your individual prognosis, talk to your doctor.

Talk With Others Who Understand

MyMyelomaTeam is the social network for people living with multiple myeloma and their loved ones. More than 11,600 members come together to ask questions, give advice, and share their stories with others who understand life with myeloma.

Are you living with stage 1 multiple myeloma? Share your experience in the comments below, or start a conversation by posting on MyMyelomaTeam.

Mark Levin, M.D. is a hematology and oncology specialist with over 37 years of experience in internal medicine. Review provided by VeriMed Healthcare Network. Learn more about him here.
Maureen McNulty studied molecular genetics and English at Ohio State University. Learn more about her here.

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