7. Stages and classifications
The criteria as discussed above helps doctors determine not only whether a person has the disease, but also under which classification the disease falls. Those classifications are:
- Monoclonal gammopathy of undetermined significance (MGUS)
- Asymptomatic myeloma, which is then divided into two subcategories:
- Smoldering myeloma
- Indolent myeloma
- Symptomatic myeloma
Once the classification is known, a doctor will then determine which stage of the disease exists, which will help establish the prognosis and treatment options.
The most common way to diagnose the stage of the disease is through the International Staging System (ISS), which is based on two different blood test results: the beta 2-microglobulin (β2-M) and the albumin. There are three stages of classification under the ISS:
- Stage I: β2-M less than 3.5 mg/L and albumin greater than or equal to 3.5 gm/dL
- Stage II: Either β2-M greater than 3.5 mg/L but not greater than 5.5 mg/dL and/or albumin less than 3.5 g/dL
- Stage III: β2-M greater than 5.5 mg/L
The Durie-Salmon Staging System is an older system of diagnosis. This uses four measurements to determine which stage of the disease exists: 1) the amount of hemoglobin in the blood; 2) the amount of calcium in the blood; 3) the production rate of M protein; and 4) the number of bone lesions. The disease’s stage is then further subdivided based on kidney function.
The three stages of the disease as determined by the Durie-Salmon Staging System are: Stages I, II and III. Each of these stages is then subdivided into either Stage A or Stage B based on whether kidney function is affected. (Stage B means there is significant kidney damage.)
- Stage I: Though a person with Stage I often shows no symptoms of the disease because there are fewer cancer cells present in the body, other signs will be present, such as: amount of red blood cells within or a little below the normal range, a normal amount of calcium in the blood, low levels of M protein in the urine or blood.
- Stage II: More cancer cells are present in the body than in Stage I. An individual who does not fit into either Stage I or Stage III is said to have Stage II.
- Stage III: There are many cancer cells present. Other characteristics of this stage include; hypercalcemia, high levels of M protein, anemia, and significant bone damage.
Note: In any stage, if kidney function is affected, the prognosis will be worse.
8. It’s treatable, not curable
The most common multiple myeloma treatment has typically been chemotherapy followed by stem cell transplants. Because the disease is not curable, this method of treatment aimed to create longer and longer stretches of time during which it did not progress. Now, however, significant advances in research have dramatically changed not only the prognosis but the treatment that is offered. In fact, treatments have advanced so much that there is an increasing discussion among the scientific community as to whether a stem cell transplant should be done after diagnosis or if it is better to wait until a relapse.
Scientists are currently experimenting with different combinations of medications to increase the survival rate. For example, efforts are being made to combine certain drugs that not only have diminished side effects but that also “lengthen stretches of progression-free survival (PFS). 9 Other drugs are being studied to see how they can work with the body’s immune system to fight the disease.
“It’s a massive convergence of our understanding of biology, the technology becoming available to understand myeloma cells and how they respond, the genetic subtypes of myeloma, the ability to engage both the patient community and researcher, to transfer data and information,” says Walter Capone, president and CEO of the Multiple Myeloma Research Foundation, in an article with Cure. 10
9. There’s an international support network
The International Myeloma Foundation—while not an official sponsor of the more than 150 multiple myeloma support groups around the world—conducts yearly conferences for support group leaders. Information on support groups according to an individual’s geographical location can be found on the IMF website.
10. The survival rate continues to increase
According to Cancer Research UK (which used data from 2010-2011), 78 percent of men diagnosed with the disease survive for at least one year and 50 percent survive for five years or longer. For women, that number is 75 percent for one year and 44 percent for at least five years or longer. 11
In the United States, researchers reported that a “newly diagnosed myeloma patient 15 years ago, for example, was about one-third as likely as someone without myeloma to live another five years.” 12 Those same researchers found that “By the end of the 2000s, in contrast, that same myeloma patient would be 45 percent as likely as someone without myeloma to live another five years.” 13 According to the American Cancer Society, the median survival rate for Stage I is 62 months; Stage II: 44 months; and Stage III, 29 months. 14
With advances in treatment, as well as ongoing clinical studies, those prognoses continue to increase. In fact, the prognosis today of someone diagnosed with the disease is nearly triple what it once was. 15