What is multiple myeloma?

Multiple myeloma is a cancer of the blood. It develops in plasma cells, which are white blood cells that help fight infection. In multiple myeloma, cancer cells build up in bone marrow and take over the healthy blood cells. They create abnormal proteins that can damage your kidneys. Multiple myeloma affects more than one area of your body. Symptoms include bone pain and easily broken bones. You may also experience:

  • frequent infections and fevers
  • excessive thirst
  • increased urination
  • nausea
  • weight loss
  • constipation

You may not require treatment until symptoms develop. Most people respond well to treatments that include:

Rocking chemotherapy

In some cases, a bone marrow or stem cell transplant is an option.

Multiple myeloma isn’t considered “curable,” but symptoms wax and wane. There can be a long period of dormancy that could last several years. However, this cancer usually recurs.

There are several types of myeloma. Multiple myeloma is the most common type. It accounts for 90 percent of cases, according to the Leukemia and Lymphoma Society. The National Cancer Institute’s Surveillance, Epidemiology, and End Results Program (SEER) lists myeloma as the 14th most common type of cancer.

Staging multiple myeloma

It’s important to remember that the outlook for everyone with multiple myeloma is different. Your treatment options and general state depend on a variety of factors.

One of those factors is the stage of the cancer at diagnosis. Like many diseases, multiple myeloma is broken down into various stages.

Staging helps doctors track your disease and prescribe the right treatments. The sooner you receive a diagnosis and start treatment, the better your outlook.

There are two main systems used to stage multiple myeloma:

  • International Staging System (ISS)
  • Durie-Salmon system

The Durie-Salmon system is based on the level of calcium in a person’s blood along with the proteins hemoglobin and monoclonal immunoglobulin.

The stages of multiple myeloma also take into account whether or not the cancer is causing problems with your bones or kidneys. High levels of blood calcium can indicate advanced bone damage. Low levels of hemoglobin and high levels of monoclonal immunoglobin indicate more advanced disease.

Most doctors divide multiple myeloma into four stages:

Smoldering stage

Myeloma that isn’t causing active symptoms is called the “smoldering stage,” or Durie-Salmon stage 1.

This means that there are myeloma cells present in your body, but they’re not progressing or causing any damage to your bones or kidneys. They may also be undetectable in your blood.

Stage 1

In this stage, you have a relatively small number of myeloma cells in your blood and urine. Your hemoglobin levels are only slightly below normal. Bone X-rays may look normal or show only one affected area.

Stage 2

In this stage, a moderate number of myeloma cells are present. Hemoglobin levels are usually much lower than normal. Monoclonal immunoglobulin may be increased, and blood calcium levels may also be high. X-rays may show several areas of bone damage.

Stage 3

In the final stage of multiple myeloma, a high number of myeloma cells are found. Your hemoglobin level is also usually below 8.5 grams per deciliter, and calcium blood levels are high. There are multiple areas of bone destruction caused by the cancer.

What’s the outlook?

Your age also affects your outlook. Younger people tend to do better than older people. Other health conditions and your choice of treatment must also be taken into consideration.

For some people, multiple myeloma can be asymptomatic and progress slow. Poor kidney function and faster growing cancer cells generally indicate a poorer outlook. But if you respond well to initial treatment and experience a complete remission, your outlook is generally better.

After treatment, you’ll need regular follow-up testing and disease management care. You’ll be advised to drink lots of fluids to help your kidneys function properly. Because of your weakened immune system, you’ll also have to take extra precautions to avoid infections. Taking care of yourself can help you feel better and may lengthen your life.

Survival rates

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

  • Stage 1: 62 months, which is approximately five years
  • Stage 2: 44 months, which is approximately three to four years
  • Stage 3: 29 months, which is approximately two to three years

It’s important to note that survival rates are calculated from the time treatment begins. The average is the median survival rate. This means that half of the people with multiple myeloma lived longer than the average length for each stage.

These figures include people treated over the past 5 to 25 years. The ACS notes that treatment has improved a great deal during that time period. This means that survival rates will hopefully continue to improve.

Stats show that the five-year relative survival rate improved dramatically from 1975 to 2012:

Year5-year survival rate

More facts and stats

In the United States, myeloma is the 14th leading cause of cancer deaths. SEER estimates that in 2018, there’ll be 30,280 new cases and 12,590 deaths. That’s only 2.1 percent of all cancer deaths. It’s estimated that in 2014, an estimated 118,539 Americans were living with myeloma. The lifetime risk of developing myeloma is 0.8 percent.

Multiple myeloma is almost exclusively diagnosed in people aged 65 or older. People under age 35 represent less than 1 percent of cases, according to the ACS.

Coping with a multiple myeloma diagnosis

Receiving a diagnosis of multiple myeloma can be difficult to cope with. You may have questions about the disease, your treatment, and your outlook.

It can be helpful to start by educating yourself and your loved ones about multiple myeloma so you, and those around you, know what to expect. Learning more about multiple myeloma will help you and your caregivers make appropriate decisions about your care. You can find information at your local library and by searching online.

Establish a strong support system of people who can help you cope with any problems or anxieties you may have. This can include caregivers, loved ones, and medical experts. You might also benefit from talking with a mental health therapist about the feelings you have.

You may also benefit from joining a multiple myeloma support group. You’ll be able to meet others who have multiple myeloma. They can offer advice and tips for coping. When coping with your diagnosis, be sure to take enough time to recover. Treat your body well. Eat healthfully. And get enough rest and relaxation so you’re better able to deal with stress and fatigue. Set achievable goals that help you feel satisfied without overextending yourself.

Myeloma Warrior, during Stem Cell Transplant process — 18 straight 8:00 a.m.- 5:00 p.m. appointments — including weekends — at the Duke Adult Bone Marrow Transplant center.

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