Stage 3 Multiple Myeloma

What is stage 3 Multiple Myeloma?

Patients are said to have stage 3 multiple myeloma if their serum beta 2 microglobulin levels are 5.5 mg/L or higher [¹]. In simpler terms, it means that the cancer cells have spread throughout the body. Given the difficulty of catching multiple myeloma early, most patients are likely to be diagnosed with late-stage multiple myeloma.

By the time symptoms of multiple myeloma appear, the cancer will have spread to different parts of the body and cause severe damage to the organs, putting the patient in the late stages of the disease. Late-stage multiple myeloma starts when the patient has extremely low levels of red blood cell counts (referred to as anemia).

Patients are also likely to have high levels of calcium in their blood, along with significant kidney damage and low levels of protein molecules in the red blood cells for carrying oxygen.

What are the subtypes of stage 3 Multiple Myeloma?

Unlike stages 1 and 2, stage 3 multiple myeloma is considered to be terminal and spread throughout different parts of the body; therefore, it does not have subtypes. Due to how far the cancer has already spread in patients, doctors don’t find it useful to create subtypes for stage 3 multiple myeloma.

However, two other common classifications for multiple myeloma are monoclonal gammopathy of undetermined significance (MGUS) and smouldering multiple myeloma (SMM). MGUS is characterized by low levels of M protein, which means that the level of abnormal plasma cells is very low, but there is no other evidence for myeloma.

SMM is characterized by high levels of M protein and plasma cells, but there is no other evidence of signs of multiple myeloma.

Stage 3 Multiple Myeloma staging and diagnosis

Multiple Myeloma staging

In general, the TNM system is used to describe and classify cancers. However, Multiple Myeloma does not use this system.

How common is stage 3 Multiple Myeloma?

Stage 3 multiple myeloma is not common in the United States, with an overall risk of only 0.76% for the country’s population. This means that only 1 in 132 Americans are at risk of getting the disease. According to the American Cancer Society, about 35,730 new cases of multiple myeloma have been diagnosed in the country (with 15,870 in women and 19,860 in men) [²].

How is stage 3 Multiple Myeloma diagnosed?

Most patients are asymptomatic in stages 1 and 2 of multiple myeloma. Age has been identified as the biggest risk for developing multiple myeloma. To diagnose stage 3 multiple myeloma, doctors will conduct a number of blood tests to measure the patient’s serum albumin, beta-2 microglobulin, and calcium levels in the blood.

Doctors will also look for signs of anemia by measuring red blood cell counts. If the patient is suspected of having myeloma, doctors will follow up the blood tests with imaging tests such as an MRI scan, X-ray, and PET scans to assess the level of damage done to the bones.

Blood tests can reveal useful information such as:

• Anemia: This indicates that the cancer cells are damaged bone marrow
• High levels of calcium: An indication that the tumors are damaging the bones
• High levels of creatinine and urea nitrogen: An indication that the kidneys are not working as they should
• Low albumin levels: A common indicator of stage 3 multiple myeloma
• High levels of beta-2 microglobulin: A key tumor marker for stage 3 multiple myeloma and indicates immune system activation
• Higher lactate dehydrogenase (LDH): An indication that the cancer or other underlying condition has caused tissue damage
• High CRP levels: A sign of inflammation throughout the body

Doctors use urine tests to measure the levels of monoclonal proteins. The presence of these proteins is an indication of something wrong with the plasma cells. Monoclonal proteins can be measured using several tests, including:

• Serum-free light chain assay
• Quantitative immunoglobulin testing
• Urine protein electrophoresis
• Serum protein electrophoresis

A biopsy is then performed for a more definitive diagnosis of stage 3 multiple myeloma. This is done by the removal of a sample of bone marrow with the aid of a long needle. The sample is then analyzed for myeloma cells using specialized tests such as fluorescence in situ hybridization (FISH) [³].

Stage 3 Multiple Myeloma symptoms

Nearly a third of all people diagnosed with multiple myeloma don’t show any symptoms until after the disease has progressed to a more terminal stage. However, the most common symptoms include the following:

• Nausea
• Bone pain
• Constipation
• Loss of appetite
• Fatigue
• Confusion
• Mental fogginess

As the disease becomes progressively worse, the following symptoms may be experienced:

• Feeling very lethargic
• Easy to bleed or bruise
• Feeling very tired
• Bone pain in the ribs or back
• Fevers
• Getting frequent infections that are not easy to treat
• Excessive weight loss
• Very low appetite
• Feeling weak in the arms and legs

Stage 3 multiple myeloma can also cause rapid breakdown of bones, which can cause large deposits of calcium to make their way into the bloodstream. This is known as hypercalcemia. Some of the most common symptoms of hypercalcemia include the following:

• Dehydration
• Problems with the kidney, including kidney failure
• Confusion
• Feeling severely constipated
• Frequent urge to pee
• Excessive thirst

Excessive levels of calcium can also lead to coma, which could be fatal. Myeloma also damages the nerves and causes peripheral neuropathy, which is often described as peripheral neuropathy [⁴].

Stage 3 Multiple Myeloma treatment

Standard treatments are focused on increasing the life expectancy of patients and improving their 5-year relative survival rate. Due to the large interindividual variability in symptoms for patients, the treatment depends on a number of factors such as tumor size, overall health, age, as well as overall symptoms.

Common treatments include immunomodulatory drugs, chemotherapy, corticosteroids, and protease inhibitors, among others.

Stage 3 Multiple Myeloma {primary/first-line treatment}

The primary treatment for stage 3 multiple myeloma are protease inhibitors, steroid antibodies, and chemotherapy, among others. Although there is a difference in how each treatment works, the common goal is to control and destroy multiple myeloma cells. It is worth mentioning that many drugs are being approved for treating multiple myeloma thanks to clinical trials.

Protease inhibitors are used for treating multiple myeloma throughout all stages of the disease. These drugs prevent cancer by discarding old proteins, including cancer cells, so they can be replaced by newer cells.

Immunomodulatory drugs are the most commonly used treatments for multiple myeloma. They work by activating the immune system to prevent growth signals for cancer cells as well as killing myeloma cells. Steroids and monoclonal antibodies are popular examples of immunomodulatory drugs that are used at all stages of multiple myeloma [⁵].

Steroids work by decreasing inflammation and stopping white blood cells from flowing to diseases affected areas, which can relieve pressure and pain. Steroids are also used for managing the symptoms of chemotherapy, such as nausea and vomiting.

Other Types of Treatment for Stage 3 Multiple Myeloma

An autologous stem cell transplant is often recommended for treating multiple myeloma. This should be followed by maintenance therapy because it has been shown to improve survival rates and provides various benefits to patients.

Drug therapies are also used for relieving symptoms of multiple myeloma symptoms such as kidney failure and bone disease. This type of symptom management is known as supportive care.

Can stage 3 Multiple Myeloma be cured?

There is no cure for stage 3 multiple myeloma, but doctors can manage the disease and improve their patient’s survival rate for years. Treatments can be used to bring the disease into remission, but it may return. The disease can be fatal, and the life expectancy of patients can vary widely.

Prognosis: Stage 3 Multiple Myeloma survival rate

Stage 3 Multiple Myeloma survival rate

According to the American Cancer Society, the life expectancy for people with stage 3 multiple myelomas is 29 months [⁶]. It is worth noting that these survival rates are only estimates and are based on previous studies of people who had cancer. Anecdotal evidence has shown that the life expectancy for patients can vary from just a few weeks after diagnosis to over two years.

Stage 3 Multiple Myeloma recurrence rate

People with stage 3 multiple myeloma are very likely to have a recurrence after successful treatment. One study found that 16% of participants experienced early relapse within 12 months. However, 84% of patients had no relapse at the time of the follow-up [⁷].

Stage 3 Multiple Myeloma growth rate

Depending on the type of multiple myeloma, progression can occur at a rate of 10% per year during the first 5 years after diagnosis, 3% per year over the next 5 years, followed by 1.5% per year [⁸].

Lifestyle changes for preventing and managing Multiple Myeloma

Although it is not possible to directly affect multiple myeloma after implementing lifestyle changes, patients can significantly improve their overall mental and physical health. Here are a few recommendations for patients with stage 3 multiple myeloma.

• Quit Smoking: Smoking can significantly slow down healing and exacerbate the problems caused by drugs used for treating multiple myeloma. By quitting smoking, patients can significantly boost their immune system, which can go a long way in helping their bodies heal.
• Lower the Risk of an Infection: Multiple myeloma can significantly affect the body’s ability to fight off an infection. Relatively benign infections such as a cold can be more severe in patients with multiple myeloma. Patients can reduce their risk of infection by staying away from crowds, avoiding touching their mouth and nose after touching surfaces and washing their hands often.
• Eating a Healthy Diet: A healthy diet can go a long way in empowering the body and mind. Multiple myeloma can make patients less hungry; this is why patients should be mindful of their calorie consumption. Working with a dietitian who can help them plan meals is recommended.
• Working Out: Exercise has many benefits, including keeping the weight at a healthy level and supporting the immune system. Patients should consult with their doctor to choose a safe exercise program.
• Managing Lethargy: It is common for patients to experience fatigue due to multiple myeloma. To manage lethargy, it is important for patients to work on tasks that need their attention the most instead of focusing on menial chores that are best left for someone else.
• Support System: Getting diagnosed with stage 3 multiple myeloma can be a life-changing event. It can overwhelm patients emotionally as they start worrying about their survival rate. This is why patients should seek support groups and rely on their close friends and other people in their life. Patients should seek advice from other people who are also recovering from multiple myeloma.

Conclusion

Takeaway

Although there is no cure for stage 3 multiple myeloma, it is possible to manage its symptoms and improve the patient's quality of life as well as their 5-year survival rate. It is too early for doctors to provide patients with an estimate as to how long they may survive following diagnosis. Patients have been shown to survive anywhere from a few weeks to several years after diagnosis.

It is important to coordinate with a multidisciplinary team of doctors, dieticians, and nutritionists to come up with a treatment plan. This includes dieting recommendations, lifestyle changes such as working out, giving up smoking, and others. Patients who stay active and seek support groups improve their survival rate and improve their outlook on life.