Prognosis

Although multiple myeloma is rarely curable, it is a highly manageable disease. Overall, the prognosis, or predicted course of disease, for patients with multiple myeloma has improved greatly in the past decade due to continuing research.

Your doctor will consider a range of factors in determining your individual prognosis. This can help guide important decisions, such as which treatment is best for you and when your treatment should begin.

Learn more about multiple myeloma prognosis:



Determining multiple myeloma prognosis

The prognosis (predicted course of disease) of multiple myeloma is usually based on the existence of different signs, symptoms, and circumstances, such as your age. Another important factor is the stage of your disease as determined by the results of diagnostic testing.

Several clinical and laboratory findings, considered “prognostic indicators,” help determine how fast the tumor is growing, the extent of disease, the biological makeup of the tumor, the response to therapy, and the overall health status of the individual.

Establishing the levels of these prognostic tests early in the course of the disease is important, as it provides a baseline against which disease progression and response to therapy can be measured. Many of these tests will be performed multiple times throughout your treatment journey to help determine how well your treatment is working and which treatment should be used next.

Indicators of prognosis

Test Indication Values Indicating a More Favorable Prognosis
Beta 2-microglobulin (β2-microglobulin or β2-M) Higher levels reflect more extensive disease and poor kidney function <3 mg/mL
Albumin level Higher levels may indicate better prognosis ≥3.5 g/dL
Lactate dehydrogenase (LDH) level Higher levels indicate more extensive disease Age ≤60yrs.: 100-190 U/L
Age >60yrs.: 110-210 U/L
FreeliteTM serum free light chain assay Abnormal results may indicate poor prognosis (also indicates risk of progression of MGUS or asymptomatic myeloma or symptomatic myeloma Free light chain ratio MGUS: 0.26-1.65
Asymptomatic myeloma:0.125-8.0
Symptomatic myeloma:0.03-32
Chromosome analysis (cytogenetic testing by either karyotyping or FISH) Presence of specific adnormalities may indicate poor prognosis Absence of adnormalities
Gene expression profiling Presence of specific group of genes can predict low or high risk of early relapse Personalize risk score


Understanding survival statistics

Some people who have been diagnosed with a disease like multiple myeloma want to know their exact probability of survival. Others prefer not to know. It’s a very personal decision, and either approach is perfectly fine. If you would like to see the latest data available on survival rates, you can find them under the last section on this page, “Relative survival for multiple myeloma.”

Before deciding, however, it’s important to understand that statistics cannot and do not tell you what will happen—they can tell you only what has happened to others. The relevance of the statistics depends on how similar to you, in terms of patient demographics and treatment options, those “others” happen to be. Here are a few additional things to consider:

  • There are several ways of measuring survival. The data presented below measure survival in terms of five-year relative survival. This refers to the number of individuals living 5 years after being diagnosed with multiple myeloma.
  • It’s common for cancer statistics to be based on research gathered over a five-year period; “five-year relative survival” does not imply that few patients live beyond five years.
  • Relative survival statistics factor in only death due to cancer, rather than death due to other causes.
  • The data presented below reflect five-year survival for the period between 2007 and 2013. This is the most recent data available. Since 2013, a great deal of progress has been made toward advancing multiple myeloma treatments, so these data likely underestimate improvements made in relative survival in the past few years.
  • The five-year relative survival rate includes all individuals diagnosed with multiple myeloma. It includes everyone who received treatment, as well as everyone who did not.
  • A number of factors, including your age and the stage of your disease, can have a significant impact on your prognosis. However, none of these factors can conclusively tell you your prognosis.
  • In researching multiple myeloma, you may encounter other statistics related to survival, incidence, and outcomes for specific treatments. You may find it helpful to discuss any statistics with your doctor(s).

Relative survival for multiple myeloma

From 2007 to 2013, five-year relative survival for multiple myeloma was 49.6%, meaning that approximately 50 of 100 people with multiple myeloma were living five years following their diagnosis.

To put that statistic into perspective, the five-year relative survival rate for multiple myeloma just 13 years ago was 34.5%. The trend for multiple myeloma survival is improving. Thanks to collaborative research efforts promoted by the Multiple Myeloma Research Foundation (MMRF), newer, better treatments are arriving all the time. Since 2013, several new multiple myeloma drugs have been approved by the Food and Drug Administration (FDA).



Stages of multiple myeloma

Staging of multiple myeloma refers to the degree to which the cancer has progressed, and it is an important consideration for developing the most effective treatment plan.

Doctors determine the stage of multiple myeloma through diagnostic testing.

International Staging System (ISS)

The most commonly used staging system in multiple myeloma is the International Staging System. It is based primarily on two blood test results: beta2-microglobulin (ß2M) and albumin. ß2M is a protein that indicates the extent of disease, while albumin is an indicator of overall general health. The ISS was recently revised to incorporate additional risk factors as well.

Revised International Staging System for multiple myeloma

 

Stage Criteria
I ß2-M<3.5mg/L and albumin ≥3.5 g/dL and
Absence of high-risk DNA abnormalitiesaand
Normal lactate dehydrogenase (LDH)
II Not Stage I or III
III ß2-M≥5.5mg/L and
Presence of high-risk DNA abnormalitiesaor
High LDH
ß2-M = beta2-microglobulin
aHigh-risk DNA abnormalities include del(17p) and/or translocation t(4;14) and/or translocation t(14;16)

 

Durie-Salmon Staging System

The Durie-Salmon Staging System is an older staging system that is still sometimes used. With the Durie-Salmon Staging System, the stage of multiple myeloma is determined based on four measurements: the amount of hemoglobin and the level of calcium in the blood, the number of bone lesions, and the production rate of M protein. Stages are then further divided according to kidney function.

Increasingly, physicians are relying less on the Durie-Salmon Staging System and more on biologically relevant markers as prognostic indicators when making treatment choices.



Minimal residual disease

What is minimal residual disease?

Minimal residual disease (MRD) refers to the number of multiple myeloma cells remaining after treatment. Undergoing therapy often kills the vast majority of multiple myeloma cells, but a few may still remain. Those remaining cells may eventually go on to grow and divide, causing a relapse.

Being able to determine how many multiple myeloma cells are left will ultimately allow your doctor to determine how well a treatment is working for you. Evaluating changes in MRD over time can show how long the effects of treatment last. Patients who achieve a complete response to therapy with no detectable MRD (known as “MRD-negative status”) have greater survival rates.

MRD measurement

Incredibly sensitive techniques to detect multiple myeloma cells have been developed, allowing for the detection of a single multiple myeloma cell among a million other cells. It is hoped that MRD measurement will ultimately help inform what treatments to use, how long those treatments will remain effective, and when to begin other types of treatment. MRD measurement could one day help researchers determine how to wipe out multiple myeloma entirely, making MRD-negative status the new definition of success of multiple myeloma treatment.

While MRD measurement is a promising new area of research, its use has not yet been approved by the FDA. In order for MRD measurement to gain approval, the FDA will evaluate the data to determine if and how doctors should use it.

The MMRF is helping to accelerate FDA approval of MRD measurement by partnering with Memorial Sloan Kettering Cancer Center to organize a meeting with the FDA, the National Cancer Institute, and key members of the biotechnology and pharmaceutical industries. Additionally, the MMRF has collaborated with Adaptive Biotechnologies, the University of Torino, and Amgen/Onyx in a groundbreaking clinical trial, INSIDE MM-1, to perform both flow cytometry and molecular sequencing (clonoSEQ®) evaluation—the two main methods for measuring MRD—on hundreds of multiple myeloma patients.

The importance of MRD

MRD resources for researchers

Roundtable discussion: advances in MRD testing in myeloma

Minimal Residual Disease (MRD) is a hot topic today in the field of multiple myeloma (MM), in great part because we finally have very active treatment regimens that can bring deep and sustained responses to patients.



Relapsed and refractory disease

Relapsed (or “recurrent”) multiple myeloma is the term for when cancer returns after treatment or after a period of remission. Since multiple myeloma does not have a cure, most patients will relapse at some point.

Refractory multiple myeloma refers to when the cancer does not respond to therapy. In some patients, the cancer may respond to initial treatment, but not to treatment following a relapse.

Fortunately, there are many treatment options available for people with relapsed or refractory disease. It’s important to discuss your treatment options with your doctor—and to seek a second opinion from a doctor with expertise in treating multiple myeloma. Doctors at larger cancer centers, in particular, may have more knowledge about treating multiple myeloma and access to more clinical trials specifically for relapsed or refractory disease.