Stage 1 Multiple Myeloma

What Is Stage 1 Multiple Myeloma

Multiple myeloma is a type of cancer that affects the plasma cells in the body, affecting the production of white blood cells. It is a complex and heterogeneous disease often diagnosed in later stages and causes abnormal growth of cells in the bone marrow [1]. However, the disease is detected early in some cases, and the patient is diagnosed with Stage 1 multiple myeloma.

Stage 1 multiple myeloma is an early-stage cancer, and it is characterized by a low level of cancer cells in the bone marrow, which is the spongy tissue inside bones where blood cells are produced.

What Are the Substages of Stage 1 Multiple Myeloma?

Stage 1 multiple myeloma is the earliest stage of the disease and is among the primary cancers, and it is further subdivided into two substages: IA and IB.

Stage 1A cancer is characterized by low levels of M-proteins in the blood and urine and low levels of abnormal plasma cells in the bone marrow. M-proteins are abnormal antibodies produced by myeloma cells that can be detected in blood and urine tests. In substage IA, the M-protein level is less than or equal to 3 grams per deciliter (g/dL), and the percentage of abnormal plasma cells in the bone marrow is less than or equal to 10% [²].

Substage IB of Stage 1 multiple myeloma is characterized by slightly higher levels of M-proteins and abnormal plasma cells than substage IA. In substage IB, the M-protein level is between 3 and 5 g/dL, and the percentage of abnormal plasma cells in the bone marrow is between 10% and 30% [³].

Classifying Stage 1 multiple myeloma into substages IA and IB is important because it can help doctors determine the appropriate treatment plan for the patient. Patients with substage IA may be monitored closely without treatment. In contrast, patients with substage IB may benefit from early intervention with low-dose chemotherapy or other stage 1 cancer treatments to slow the progression of the disease.

It is important to note that classifying multiple myeloma into stages and substages is just one aspect of the disease. Each patient's condition should be evaluated individually by a team of medical professionals. The treatment plan for multiple myeloma will depend on several factors, including the patient's age, overall health, and the specific characteristics of the disease.

Stage 1 Multiple Myeloma Staging and Diagnosis

Multiple Myeloma Staging

Multiple myeloma cancer is staged by using the Revised Internation Staging System (RISS), which uses four factors to determine how far the cancer has grown, and all stages of cancer are determined similarly [4]. What determines stages of cancer can include:

• Amount of albumin in the blood
• Amount of beta-2-microglobulin in blood
• amount of LDH in the blood
• Cytogenetics (abnormalities in the gene)

Multiple myeloma is divided into three main types based on cancer growth:

• Monoclonal Gammopathy of Undetermined Significance (MGUS): There are only a few myeloma cells in the bone marrow, and no symptoms are present. This is also considered a pre-cancer stage.
• Asymptomatic (Indolent) or Smoldering Multiple Myeloma (SMM): The cancer cell amount is greater than in MGUS, but there is no damage to the body.
• Symptomatic (Active): This is also considered over cancer, where the amount of cancer cells is high and causes damage to the body, such as anemia and hypercalcemia.

How Common Is Stage 1 Multiple Myeloma?

According to the American Cancer Society, there is a 0.76% lifetime risk of developing multiple myeloma stage one cancer. In 2023, ACS estimates that about 45,000 people will be diagnosed at the early stages of cancer [⁵]. However, diagnosing stage one multiple myeloma is difficult, as it does not show any symptoms. About 20% of people that have multiple myeloma are diagnosed at the early stage and have localized cancer [⁶].

How Is Stage 1 Multiple Myeloma Diagnosed?

In the early stage of cancer, known as Stage 1 multiple myeloma, the disease may not cause any noticeable symptoms and may be detected incidentally during routine blood tests. However, if multiple myeloma is suspected, several tests may be used to confirm the diagnosis.

• Blood tests: A complete blood count (CBC) can detect changes in the number of red and white blood cells and platelets in the blood [⁷]. In multiple myeloma, there may be a decrease in the number of red blood cells (anemia) and an increase in the number of abnormal plasma cells. Other blood tests can detect the presence of M proteins, abnormal proteins produced by myeloma cells, using mass spectrometry [⁸].
• Urine tests: Myeloma cells can produce abnormal proteins excreted in the urine, which can be detected using a urine test. This test is called urine protein electrophoresis (UPEP) or urine immunofixation electrophoresis (IFE) [⁹].
• Bone marrow biopsy: It entails taking a sample of bone marrow from the hip bone using a long, thin needle. The sample is then examined under a microscope for abnormal plasma cells. This test is essential for the diagnosis of multiple myeloma [¹⁰].
• Imaging tests: Imaging tests, such as X-rays, computed tomography (CT) scans, magnetic resonance imaging (MRI), or positron emission tomography (PET) scans, can detect bone damage or other abnormalities that may be caused by multiple myeloma [¹¹] [¹²]. These tests can also help determine the extent of the disease and whether it has spread to other parts of the body.

Stage 1 Multiple Myeloma Symptoms

Some of the common stage 1 cancer symptoms include:

• Bone pain: Multiple myeloma can cause bone pain, especially in the back, ribs, and hips. The pain can be sharp, stabbing, or aching and can worsen with movement [¹³].
• Fatigue: Fatigue is a common symptom of multiple myeloma. Patients may feel tired and weak, even after resting [¹⁴].
• Anemia: Multiple myeloma can cause a decrease in the number of red blood cells in the blood, leading to anemia. Symptoms of anemia may include fatigue, weakness, shortness of breath, and dizziness [¹⁵].
• Increased infections: Multiple myeloma can suppress the immune system, making patients more susceptible to infections. Common infections may include pneumonia, urinary tract infections, and skin infections [¹⁶].
• Numbness and tingling: Multiple myeloma can affect the nerves, causing numbness, tingling, or weakness in the hands and feet [¹⁷].
• Kidney problems: Multiple myeloma can cause kidney damage, leading to symptoms such as decreased urine output, swelling in the legs and feet, and fatigue [¹⁸].

It is important to note that other conditions can also cause these symptoms and that not all patients with multiple myeloma will experience them. However, if you are experiencing any of these symptoms, you must consult your doctor for an evaluation and diagnosis.

Stage 1 Multiple Myeloma Treatment

Stage 1 Multiple Myeloma Primary/First-Line Treatment

The primary treatment of cancer stage 1 multiple myeloma is immunotherapy. Immunotherapy is a stage 1 cancer treatment that helps the immune system recognize and attack cancer cells. It is a rapidly evolving field and is increasingly used in treating multiple myeloma, including stage 1 disease.

In multiple myeloma, the cancer cells produce abnormal proteins that can suppress the immune system's ability to recognize and attack the cancer cells. Immunotherapy activates the patient's immune system to recognize and attack cancer cells.

Several types of immunotherapies may be used to treat stage 1 multiple myeloma:

• Monoclonal antibodies: Monoclonal antibodies are laboratory-produced proteins that can target specific proteins on the surface of cancer cells. In multiple myeloma, monoclonal antibodies may target a protein called CD38, which is found on the surface of myeloma cells. Monoclonal antibodies can mark the cancer cells for destruction by the immune system or may directly kill them [¹⁹].
• Checkpoint inhibitors: Checkpoint inhibitors are drugs that can help the immune system attack cancer cells without restraint. These drugs target proteins that help cancer cells evade the immune system [²⁰].
• CAR-T cell therapy: CAR-T cell therapy is a type of immunotherapy that involves modifying the patient's T cells (a type of immune cell) to recognize and attack cancer cells. The modified T cells are then infused back into the patient's bloodstream. CAR-T cell therapy has shown promising results in treating multiple myeloma, including in patients with relapsed or refractory disease [²¹].
• Vaccines: Vaccines can stimulate the immune system to recognize and attack cancer cells. In multiple myeloma, vaccines are being developed to target specific proteins on the surface of myeloma cells [²²].

Immunotherapy is generally well-tolerated, with side effects including fatigue, fever, and flu-like symptoms. However, the specific side effects depend on the type of immunotherapy used.

Other Types of Treatment for Stage 1 Multiple Myeloma

Treatment for stage 1 multiple myeloma may vary depending on the patient's condition, age, overall health, and other factors. However, the treatment options may include the following:

1. Observation: Some patients with stage 1 multiple myeloma may not require immediate treatment and may be monitored closely by their healthcare team. This approach is known as observation, or watchful waiting, and involves regular monitoring of the patient's condition to detect any changes or progression of the disease.
2. Chemotherapy: Chemotherapy is a treatment that uses drugs to kill cancer cells. It may be combined with other therapies, such as corticosteroids, to treat multiple myeloma [²³]. Chemotherapy aims to slow the growth and spread of cancer cells and alleviate symptoms such as bone pain and fatigue.
3. Targeted therapy: Targeted therapy uses drugs to target specific proteins or other molecules that contribute to the growth and survival of cancer cells [²⁴]. For example, monoclonal antibodies may target and destroy myeloma cells.
4. Stem cell transplant: Stem cell transplant is a procedure that involves replacing the patient's diseased bone marrow with healthy stem cells. Stem cells can be collected from the patient's own body (autologous transplant) or a donor (allogeneic transplant) [²⁵]. This treatment is usually reserved for patients with more advanced stages of multiple myeloma but may be considered for select patients with stage 1 disease.
5. Radiation therapy: Radiation therapy uses high-energy X-rays or other types of radiation to kill cancer cells. It may treat specific areas of the body where myeloma cells are causing pain or other symptoms [²⁶].

It is important to note that the treatment choice for stage 1 multiple myeloma will depend on several factors, and patients should discuss their options with their healthcare team to determine the best approach for their case. Regular follow-up appointments and monitoring are important to assess response to treatment and detect any changes or progression of the disease.

Is Stage 1 Multiple Myeloma Curable?

There is no known cure for multiple myeloma, including stage 1 disease. However, with appropriate treatment, many patients with stage 1 multiple myeloma can live for years without their disease progressing to a more advanced stage [²⁷].

The primary goal of treatment for stage 1 multiple myeloma is to prevent the disease from progressing and to manage any symptoms that may be present. Treatment may involve chemotherapy, immunotherapy, targeted therapy, or a combination.

In addition to medical treatment, lifestyle changes can also play a role in managing the disease. This may include eating a healthy diet, exercising regularly, getting enough rest, and avoiding tobacco and excessive alcohol consumption.

Regular follow-up with a healthcare team is also important for patients with stage 1 multiple myeloma. This may include regular blood and urine tests, bone density scans, and imaging studies to monitor the disease and detect any signs of progression.

While stage 1 multiple myeloma cannot be cured, patients need to know that they can continue to lead meaningful and fulfilling lives with appropriate treatment and management. Patients must work closely with their healthcare team to develop an individualized treatment plan that meets their needs and goals [²⁸].

Prognosis: Stage 1 Multiple Myeloma Survival Rate

Stage 1 Multiple Myeloma Survival Rate

According to the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program, multiple myeloma cancer stage 1 survival rate for the first five years after diagnosis is around 57.9% [²⁹]. That means that 58 out of 100 multiple myeloma patients will survive the first five years. Moreover, the percentage of myeloma deaths is highest among people aged 75. This means that myeloma stage 1 cancer life expectancy can go as high as 75 or above with appropriate treatment. Additionally, stage 1 cancer survival rate can go as high as 79% survival rate with an appropriate and timely stage of treatment, which means that 79 out of a hundred patients will survive the first five years.

Stage 1 Multiple Myeloma Recurrence Rate

Multiple myeloma is aggressive cancer, and relapse of the disease after treatment is common [³⁰]. Moreover, people with no additional risk factors for multiple myeloma may stay in remission for several years or longer. One study evaluated the recurrence rate of multiple myeloma in over 511 patients within 12 months and found that 16% of patients showed early relapse while 84% had a relapse after one year [³¹].

Stage 1 Multiple Cancer Growth Rates

Multiple myeloma is a slow-growing cancer. However, the exact progression rate can vary depending on the patient. An older study assessed the growth rate of multiple myeloma cancer stage one in 276 people and found a ten percent risk of progression in the first five years of diagnosis. The risk decreased to three percent in the next five years and one percent in the following five years. In general, the study concluded that there was a 73% risk of multiple myeloma progression in 15 years [³²].

Lifestyle Changes for Preventing and Managing Multiple Myeloma

While there is no known cure for multiple myeloma, including stage 1 disease, lifestyle changes can be important in preventing and managing the disease. Here are some lifestyle changes that may be beneficial for patients with stage 1 multiple myeloma:

• Eating a healthy diet: A healthy diet can help support the immune system and provide the body with the nutrients it needs to function properly. Patients with stage 1 multiple myeloma may benefit from a diet with plenty of fruits, vegetables, whole grains, lean protein sources, and healthy fats [³³]. It is also important to stay hydrated by drinking plenty of water.
• Maintaining a healthy weight: Obesity has been linked to an increased risk of developing multiple myeloma and other types of cancer [³⁴]. Maintaining a healthy weight through diet and exercise may help reduce the risk of developing multiple myeloma and improve outcomes for patients who have already been diagnosed.
• Getting regular exercise: Regular exercise has been shown to have several health benefits, including reducing the risk of cancer and other chronic diseases. For patients with stage 1 multiple myeloma, regular exercise may help improve strength, balance, and overall health [³⁵]. However, talking to a healthcare provider before starting an exercise program is important to ensure it is safe and appropriate for individual needs.
• Managing stress: Chronic stress can harm the immune system, making it more difficult for the body to fight off cancer cells. For patients with stage 1 multiple myeloma, managing stress through meditation, deep breathing, and mindfulness may help improve overall health and well-being [³⁶].
• Avoiding tobacco and excessive alcohol consumption: Tobacco use and excessive alcohol consumption have been linked to an increased risk of multiple myeloma [³⁷]. For patients with stage 1 multiple myeloma, it is important to avoid tobacco use and limit alcohol consumption to reduce the risk of disease progression and other health problems.

In addition to these lifestyle changes, patients with stage 1 multiple myeloma must work closely with their healthcare team to develop an individualized treatment plan that meets their needs and goals. This may involve medical treatment, lifestyle changes, and supportive care to manage symptoms and improve the overall quality of life [³⁸].

Conclusion

Takeaway

Stage 1 multiple myeloma is a relatively early and less aggressive disease stage, often diagnosed incidentally during routine blood tests. Although the prognosis is generally good, close monitoring and follow-up are necessary to detect any disease progression and ensure the best possible outcome for the patient.