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Multiple myeloma is a rare type of blood cancer that starts in your plasma cells. Your plasma cells are a type of white blood cell inside your bone marrow, the soft inner part of your bones.
If you have multiple myeloma, your healthcare team will conduct further testing to determine the cancer’s stage. Staging refers to the process of determining how advanced a cancer is. This process is essential for determining your prognosis and developing an appropriate treatment plan.
There are three stages of multiple myeloma. Each stage can cause different symptoms and require different treatments.
To get diagnosed with multiple myeloma, you would have already gone through blood tests, urine tests, imaging studies, and biopsies. Healthcare providers then perform additional blood tests and genetic testing to determine the cancer stage.
Blood Tests
Multiple myeloma stages relate to how much of certain substances you have in your blood. A healthcare provider uses blood tests to determine your levels of these various substances. Blood tests used to stage multiple myeloma include:
- Albumin test: This test looks for a type of protein in the blood called albumin, which is often low in people with multiple myeloma.
- Beta-2 microglobulin (B2M) test: This test measures a type of protein in the blood that is considered a tumor marker, a substance made by cancerous cells. Multiple myeloma cells produce high amounts of B2M in the blood and urine. High levels may indicate more advanced-stage cancer.
- Lactate dehydrogenase (LDH) test: LDH is an enzyme in the blood that helps your cells make energy. High levels of LDH in your blood may indicate tissue damage in the body and more advanced cancer.
Cytogenetics
Cytogenetics is a way of looking for genetic abnormalities in cells. Cytogenetic tests use blood, tissue, or bone marrow samples to look for chromosomal changes in your cells. Your healthcare team may recommend taking a bone marrow biopsy to test the chromosomes in the cancer cells.
Chromosomes are the 46 threadlike structures in your cells that contain DNA, your genetic material. Certain chromosomal changes in cancer cells may indicate the disease is more aggressive.
Certain chromosomal changes are considered indicators of poor prognosis in people with multiple myeloma. For example:
- The deletion of chromosome 17, where part of chromosome 17 is missing
- Translocation, when part of one chromosome breaks off and attaches to a different one
- Translocation of chromosomes 4 and 14 and translocation of chromosomes 14 and 16
Multiple Myeloma Staging System
Healthcare providers use the Revised International Staging System (RISS) to stage multiple myeloma. This staging system is different than other types that measure the size of a tumor to determine the stage. RISS is based on four factors:
- Blood albumin levels
- Blood beta-2 microglobulin levels
- Blood LDH levels
- Presence of chromosomal abnormalities in the bone marrow cells
| Multiple Myeloma Staging System | ||||
|---|---|---|---|---|
| Stage of Multiple Myeloma | Albumin (grams per deciliter) | B2M (milligrams per liter) | LDH | Chromosomal Abnormality |
| Stage 1 | 3.5 g/dL or greater | Less than 3.5 mg/L | Normal levels | Not considered high-risk |
| Stage 2 *No specific lab values; stage 2 means criteria for stages 1 or 3 are not met |
N/A | N/A | N/A | N/A |
| Stage 3 | Not specified | 5.5 mg/L or greater | High | Considered high-risk |
Stage 1 is the earliest stage of multiple myeloma. During this stage, the cancer is considered slow-growing and is treatable. You may not have symptoms. People with stage 1 multiple myeloma have high levels of albumin in their blood.
Treatment for early-stage multiple myeloma usually includes a combination of medications for several months. Your healthcare team may refer to this type of treatment as induction therapy. The goal of induction therapy is to cure the cancer and enter remission (no cancer).
The types of medications used to treat stage 1 multiple myeloma may include:
- Chemotherapy: Drugs used to kill fast-growing cells, including cancer cells
- Corticosteroids: Medications that treat pain and inflammation and may improve nausea from chemotherapy drugs
- Immunomodulatory drugs (IMiDs): Drugs that improve the body’s immune response to cancer cells
- Proteasome inhibitors: Medications that slow the division and multiplication of cells
- Monoclonal antibodies: Man-made antibodies that can target specific proteins in cancer cells to destroy them
- Biospecific T-cell engagers (BiTEs): Drugs that boost the immune system’s response to multiple myeloma cells
- Nuclear export inhibitors: Drugs that kill cancer cells by blocking the cell’s nucleus from transporting proteins
- Bisphosphonates: Drugs used to strengthen the bones because multiple myeloma weakens the bones over time
People with stage 2 multiple myeloma have lab values that do not meet the criteria for stage 1 or stage 3. Stage 2 is more serious than stage 1 but is still treatable. You may have some symptoms of multiple myeloma, like bone pain.
Treatment options for stage 2 multiple myeloma include medications and stem cell transplant. Your healthcare provider may recommend using the same medications used to treat stage 1 multiple myeloma for up to one year.
A stem cell transplant, also known as a bone marrow transplant, involves replacing your hematopoietic (immature) blood cells with healthy ones from a donor’s bone marrow or cord blood. Stem cell transplants might use your own healthy cells collected earlier, usually before chemotherapy.
After these treatments, your healthcare provider may prescribe maintenance therapy with a single drug to prevent the cancer from coming back.
Stage 3 is the most advanced stage of multiple myeloma. People with stage 3 multiple myeloma have high-risk disease, meaning they are more likely to have a poor outcome. With stage 3, lab values show high levels of serum beta-2 microglobulin and lactate dehydrogenase. There may also be chromosomal abnormalities in the cancer cells.
This advanced stage of the disease is difficult to treat, and remission may not be possible. The goal of stage 3 treatment is usually symptom improvement and comfort.
Treatment options for stage 3 multiple myeloma are similar to those for stage 2 and include medications and stem cell transplant. A combination of medications may help slow the progression of the disease. Your healthcare team may recommend a stem cell transplant if your cancer does not respond to medications.
Following the treatment plan you and your healthcare provider decide on may be the best way to help prevent or slow the progression of multiple myeloma. Some people’s multiple myeloma never goes away, and they need to live with ongoing treatment to help keep the cancer in check.
People who have multiple myeloma are at an increased risk for other types of cancer. You may develop another type of blood cancer after achieving remission. To lower your risk of cancer coming back (recurrence), focus on healthful habits like:
- Avoid smoking and tobacco smoke
- Maintain the weight you and your provider decide is optimal for you
- Engage in daily physical exercise
- Eat a nutrient-rich diet that includes vegetables, fruits, and whole grains
- Avoid alcohol
Going through multiple myeloma treatment can feel overwhelming, and you may experience a range of emotions. Consider meeting with a therapist or support group to talk about your experience and learn strategies that can help you cope with stress and other feelings.
Multiple myeloma causes several physical changes that may require supportive treatments. Possible complications of multiple myeloma and its treatment include:
- Bone problems: Multiple myeloma weakens the bones and causes bone pain and fractures. Your healthcare team may recommend medications to strengthen the bones.
- Infection: Multiple myeloma affects your body’s antibodies that prevent infection. Your healthcare team may prescribe antibiotics to lower your risk of infection while undergoing multiple myeloma treatment.
- Anemia: People with multiple myeloma are at risk for having low red blood cell counts (anemia). Your red blood cells deliver oxygen throughout the body, and a lack of red blood cells may cause fatigue, dizziness, and shortness of breath. Your healthcare team may recommend medications or blood transfusions to increase red blood cell counts.
- Hyperviscosity: People with multiple myeloma may experience a buildup of proteins in the blood that lead to thicker blood (hyperviscosity). This causes problems with circulation. Your healthcare team may recommend a procedure known as plasmapheresis to remove the excess proteins.
An oncologist uses multiple tests to stage multiple myeloma. Your healthcare team will use the Revised International Staging System (RISS) to determine if you have stage 1, stage 2, or stage 3 multiple myeloma.
This staging system is based on blood lab values and chromosomal changes in the cancer cells. Your healthcare team will use your stage to determine an appropriate treatment plan.
