Multiple myeloma is a type of blood cancer that affects plasma cells. Plasma cells are white blood cells that produce antibodies to fight infections. In multiple myeloma, cancerous plasma cells (called multiple myeloma cells) crowd out normal cells in the bone marrow, resulting in loss of function of the normal bone marrow cells. Instead of producing helpful antibodies as normal plasma cells do, myeloma cells produce abnormal antibodies that can build up in tissues and be harmful.
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.
Cancers are staged according to many criteria specific to each type of cancer. Oncologists (doctors who specialize in diagnosing and treating cancer) use blood tests to determine the stage of a person’s multiple myeloma.
There are two staging systems for multiple myeloma: the Durie-Salmon Staging System and the International Staging System (ISS). The ISS replaced the Durie-Salmon Staging System in 2005. The ISS was revised in 2015 — called the Revised ISS (R-ISS) — to include additional factors affecting the severity of multiple myeloma.
In the R-ISS, there are three stages of multiple myeloma. The higher the number, the later the stages, which indicates more severe disease. In other words, stage 2 multiple myeloma is more advanced and more severe than stage 1.
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.
The R-ISS indicates stage 2 multiple myeloma when clinical test results are between those of stage 1 and stage 3. In other words, stage 2 is indicated when a person exhibits some of the factors characteristic of stage 1 and of stage 3.
Stage 1 multiple myeloma is indicated when the person exhibits all of the following factors:
The R-ISS indicates stage 3 multiple myeloma when the person exhibits beta-2 microglobulin level of 5.5 milligrams per liter or higher, along with high-risk cancer genetics and/or high LDH levels.
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.
Sometimes, a doctor will detect signs of myeloma on blood tests 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:
If you are experiencing bone pain or any other symptoms of multiple myeloma, talk to your doctor.
Most forms of active multiple myeloma, including stage 2, are treated in a similar way. People with myeloma generally receive a combination of different drugs, including chemotherapies, biological therapy, or monoclonal antibodies. Other options may include:
People with stage 2 myeloma may need to use more aggressive treatment options than those with stage 1 disease.
Many people with multiple myeloma also use supportive treatments. These are therapies that don’t aim to kill cancer cells. Rather, supportive treatments help improve myeloma signs and symptoms. For example, people with stage 2 myeloma may use bisphosphonate drugs to treat bone pain and strengthen bones.
Between the years 2011 and 2017, the overall five-year survival rate for multiple myeloma was 55.6 percent. That means that 55.6 percent of people with multiple myeloma were alive five years after their diagnosis. Cancer treatments are improving, so today’s outlook for multiple myeloma is likely better than what’s reported.
Survival statistics vary among people with different R-ISS stages, as well:
The median length of survival after diagnosis with multiple myeloma is:
Generally, a person with a later stage of cancer will have a poorer prognosis than someone with an earlier stage. Because stage 2 is a combination of factors from stage 1 and stage 3 multiple myeloma, predicting outlook and survival is often more complicated than referring to stage alone.
If a person with stage 2 multiple myeloma has three factors from the R-ISS that can be considered stage 3 and only one factor that can be considered stage 1, that person will likely have a poorer prognosis than someone who only has one factor characteristic of stage 3, for example.
In addition to the characteristics used in the R-ISS, several other risk factors contribute to the prognosis of stage 2 multiple myeloma, including:
The younger a person is when diagnosed with multiple myeloma, the longer their life expectancy will be. People with multiple myeloma who have good overall health generally have better prognoses.
Kidney function can be impaired by the abnormal proteins made by the cancerous plasma cells and by high calcium levels. People living with multiple myeloma who have abnormally functioning kidneys survive an average of 20 months compared to 40 months in people with healthy kidneys. Bone disease may also be a sign of advancing multiple myeloma and a poorer outlook for the person living with the disease.
As new treatments are approved and applied, the outlook and survival for people living with multiple myeloma should continue to improve. Ongoing cancer research, including many clinical trials, is underway to develop new cancer treatments for multiple myeloma.
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