What are the Stages of Multiple Myeloma?

This is the uncommon type of cancer that forms in plasma cells. A type of white blood cells found in the body, plasma cells, identify and battle germs and infections that attack the body.

In multiple myeloma patients, the healthy plasma cells are overtaken by cancer cells. This reduces the number of white blood cells that are available to the body. Cancer symptoms increase as the cancer cells continue to take over the healthy cells.

For myeloma, it is important to begin with whether the patient is experiencing symptoms. It is common to classify people with newly diagnosed myeloma as being either symptomatic from the disease (having symptoms and signs) or asymptomatic (not having any symptoms). Patients without symptoms are generally watched closely without specific treatment, although therapies are sometimes offered to stop the disease from growing or spreading. This is called active surveillance for smoldering myeloma (see Treatment Options). Patients with symptoms or those who are about to develop symptoms need treatment.

The symptoms of multiple myeloma can be described with the help of the CRAB mnemonic. Where

C = hypercalcemia (high blood concentration of calcium)

R = improper renal function

A = anemia

B = bone pain or lesions

 

Other problems which arise from multiple myeloma are hyper viscosity, amyloidosis, and recurring bacterial infections, which are most often serious (around 2 times in a year). Patients with multiple myeloma need to be accurately staged and treated.

 

Staging multiple myeloma

The procedure of finding out how far the cancer has progressed is known as staging. Staging is crucial for prognosis and treatment options. Prognosis is predicting the direction the illness will take and the chances for survival. Having knowledge about staging allows you to make wise decisions regarding your treatment.

ISS (International Staging System) is the system that is generally applied in staging multiple myeloma. It is centered on two results of blood tests: albumin and beta 2-microglobulin (abbreviated as B2-m). Albumin gauges the overall health, while B2-M shows how the illness has progressed.

Another staging system that is used at times is the Durie-Salmon staging system. Myeloma staging in this system is determined by four dimensions:

• Hemoglobin quantity and calcium levels in the blood
• Total bone lesions
• M protein production rate
• Kidney function

 

Durie-Salmon staging system

The Durie-salmon staging system is centered on four aspects:

1. The quantity of unusual monoclonal immunoglobulin in the blood or urine. Large quantities of this component indicate that there is the presence of many malignant plasma cells that are generating that unusual protein.

2. The quantity of calcium present in the blood. Advanced bone damage can be due to high calcium levels in the blood. Damaged bones release calcium in the blood, since bones consist of large amounts of calcium.

3. The level of bone damage according to X-rays. An advanced multiple myeloma stage is indicated by many parts of damaged bones that are displayed on the X-rays.

4. The hemoglobin quantity in the blood. Oxygen in red blood cells is transported by hemoglobin. If your hemoglobin levels are low, it means you have anemia, and this shows that myeloma cells take up a lot of bone marrow. Hence, there is no room for regular marrow cells to generate sufficient red blood cells.

The above factors are then used to divide the condition into three stages. The first stage shows the tiniest quantity of tumor, while the third stage shows the largest quantity of tumor.

The first stage                                    

Little amounts of myeloma cells are present. The following aspects must all be available:

• Slightly below normal hemoglobin levels
• One area of damaged bone or none
• Normal levels of calcium in the blood
• Small quantities of monoclonal immunoglobulin in urine or blood

 

The second stage

Medium amounts of myeloma cells can be observed, and the features are between the third and the first stage.

 

The third stage

Large quantities of myeloma cells are observed. The following must be found:

• High calcium levels in the blood
• Low levels of hemoglobin
• More than three areas of damaged bone
• High quantities of monoclonal immunoglobulin contained in the urine or blood

 

The ISS

The Internation Staging System or the ISS is a cost-effective and relatively new way to stage multiple myeloma. The ISS is a replacement of the Durie-Salmon staging system. The ISS is conducted on the basis of two blood tests: the Albumin and beta 2-microglobulin tests. The beta-2 microglobulin levels along with the albumin level shows the highest prognostic ability for staging multiple myeloma. Even though the ISS has only just been developed, it has already proven to be a significant improvement over the Durie-Salmon test, and it can clearly distinguish between the three multiple myeloma results. The three stages indicate the different levels of the survival rates estimated, as well as tell the doctor and the patient of the need to adopt more dangerous but aggressive myeloma treatment strategies.

The first stage

The levels of albumin are higher than the serum-beta-2-microglobulin in this stage.

 

The second stage                   

Both albumin and beta-2-microglobulin are on the same level.

 

The third stage    

The level of beta-2-microglobulin is higher than that of albumin.

 

Apart from stage, what other factors affect survival?

The factors include:

• Kidney function
• Age. According to the ISS, the elderly who are suffering from myeloma die early.
• Labeling index. The cancer growth rate is indicated by the myeloma cell labeling index.
• Chromosome studies. The bone marrow may be tested to assess the chromosomes in the cancer cells.

Survival rates

Survival rates are based on comparing people with myeloma to their peers who don’t have cancer. According to the American Cancer Society (ACS), these are the average survival rates by stage.

The survival rates for each stage varies, with higher stages having slimmer chances of survival as compared to lower stage individuals. The ACS has provided the following average survival rates.

• Stage 1: 62 months

• Stage 2: 44 months

• Stage 3: 29 months

One thing to note is that the survival rates are calculated from the moment the treatment begins, and the average noted here is simply the median of the survival rate. The figures shown are an average taken by the ACS over the past 25 years. There has been a significant improvement in the survival rates of individuals who began treatment after 2012. This likely means that we should see a sharp increase in survival rates in the near future.