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Multiple Myeloma Diagnosis and Staging

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“We provide a summary of current criteria and definitions that are used in diagnosis, prognosis, risk stratification and response assessment in myeloma.”

The diagnosis of cancer can be devastating. A diagnosis of incurable cancer can be beyond devastating. If you have been told that you have multiple myeloma (MM), an incurable blood cancer, your challenge is to keep your wits about you so that you can determine the stage of your MM and then your treatment plan.

Illustration of multiple myeloma plasma cellsWhy? Your age, physical condition, stage, symptoms, genetic abnormalities, etc. can mean that your prognosis is anywhere from months to years.

Your stage of MM can be determined by tests such as a 

I’m telling all this not to confuse you but to explain the importance of staging to YOU, the newly diagnosed MMer.

I am both a long-term MM survivor and MM cancer coach. I need to understand your stage at diagnosis, symptoms, and goals in order to help you figure out your therapies, both conventional (FDA approved ) or non-conventional. Understanding your MM will help figure out how MM cancer coaching can help you manage your cancer.  Here is what I can offer:

What factors make up a prognosis for multiple myeloma?

  1. Stage of the Disease: The stage of multiple myeloma at the time of diagnosis is a crucial determinant of prognosis. Staging considers factors such as the extent of bone lesions, levels of certain proteins in the blood, and the presence of symptoms.
  2. Genetic Abnormalities: Certain genetic abnormalities detected in myeloma cells, such as deletions or translocations involving chromosomes, can impact prognosis. For example, abnormalities involving chromosomes 4, 14, and 17 are associated with different prognostic outcomes.
  3. Blood and Bone Marrow Test Results: Laboratory tests, including blood tests and bone marrow biopsies, provide information on factors such as levels of monoclonal proteins (M proteins), beta-2 microglobulin, and levels of various blood cell types. These results help in assessing the aggressiveness of the disease and predicting prognosis.
  4. Kidney Function: Impaired kidney function, often indicated by elevated levels of creatinine in the blood, is associated with a poorer prognosis in multiple myeloma.
  5. Age and Overall Health: Older age and presence of comorbidities can affect prognosis. Generally, younger patients with fewer comorbidities tend to have better outcomes.
  6. Response to Treatment: Response to initial treatment, including chemotherapy, immunotherapy, and stem cell transplant, is a significant predictor of prognosis. Patients who achieve a complete or partial response to treatment typically have better outcomes.
  7. Presence of Complications: Complications such as infections, bone fractures, and neurological symptoms can impact prognosis, especially if they occur during the course of the disease.
  8. Response to Maintenance Therapy: Some patients undergo maintenance therapy (ongoing treatment after the initial therapy) to help prolong remission and improve outcomes. Response to maintenance therapy can also influence prognosis.
  9. New Therapies and Clinical Trials: Advances in treatment options, including novel targeted therapies and participation in clinical trials, can offer improved outcomes for some patients.
  10. Overall Fitness and Support System: Patient’s overall physical condition, mental health, and the support system available to them play important roles in managing the disease and coping with its challenges, which can indirectly affect prognosis.

Please watch the video below to learn more about the evidence-based, integrative therapies to combat treatment side effects and enhance your chemotherapy.

Thanks and hang in there,

David Emerson

  • MM Survivor
  • MM Cancer Coach
  • Director PeopleBeatingCancer

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Diagnosing multiple myeloma from test results

A diagnosis of multiple myeloma requires either:

  • High blood calcium level
  • Poor kidney function
  • Low red blood cell counts (anemia)
  • Holes in bones from tumor growth found on imaging studies
  • An abnormal area in the bones or bone marrow on an MRI scan
  • Increase in one type of light chains in the blood so that one type is 100 times more common than the other

OR

2. 60% or more plasma cells in the bone marrow

Multiple myeloma symptoms, diagnosis, and staging (Beyond the Basics)

“MULTIPLE MYELOMA FEATURES

MM can produce a wide variety of symptoms.

Bone symptoms — Most individuals develop bone pain in the back or chest, or less commonly, the arms and legs, at the time of diagnosis. The pain is usually triggered by movement and is absent at night, except when changing positions.

MM causes both generalized bone loss throughout the body as well as areas of bone destruction (called “lytic lesions” on X-ray) in specific areas. The tumor cells, which typically originate in the bone marrow, can extend into bone and form what are referred to as “plasmacytomas.” The bone loss and erosions can lead to osteoporosis and fractures. Many individuals with MM experience fractures of the vertebrae (the bones of the spine), which can lead to a loss of height; about 30 percent of individuals experience fractures in other bones, often with little or no preceding trauma. For this reason they are called “pathologic fractures.”

High blood calcium levels — Because bones contain large amounts of calcium, the breakdown of bone in MM can lead to high blood calcium levels (called hypercalcemia). High blood calcium levels occur in 10 to 15 percent of individuals, and the symptoms may include loss of appetite, nausea, vomiting, frequent urination, increased thirst, constipation, weakness, confusion, stupor, or coma.

Anemia — About two-thirds of individuals have anemia (low red cell count) at the time of diagnosis, and anemia eventually occurs in almost all individuals. The signs and symptoms of anemia include paleness, weakness, and fatigue.

Impaired kidney function — The excess proteins and high blood calcium levels associated with MM can damage the kidneys. Kidney function is abnormal at diagnosis in about half of individuals with multiple myeloma. Occasionally, severe kidney impairment, or kidney failure, is the first sign of MM.

Thickened blood — The excessive production of proteins by the malignant plasma cells in MM can cause a thickening of the blood (called hyperviscosity syndrome). The symptoms may include bleeding from the nose and mouth, blurred vision, neurologic symptoms, and heart failure.

Neurologic symptoms — Fractures of the vertebrae can lead to increased pressure on the nerve roots where they exit the spine, causing neurologic symptoms (called radiculopathy). This complication of multiple myeloma most commonly affects the chest, lower back, or legs, and the symptoms may include odd sensations (numbness or tingling), pain, or muscle weakness.

Occasionally, neurologic symptoms occur because plasma cells grow within the spinal canal and press on the spinal cord. The symptoms may include severe back pain, muscle weakness, especially of the legs, numbness or tingling, and loss of control of bowel or bladder function (incontinence). Spinal cord compression is a medical emergency and requires immediate treatment to relieve the pressure and prevent permanent damage.

Generalized symptoms — The generalized symptoms of MM include an increased susceptibility to infections due to immune suppression and weight loss. Immune suppression occurs because of both the underlying disease and the effects of chemotherapy. Occasionally, multiple myeloma causes increased bruising or bleeding. In individuals with advanced MM, tumor cells may accumulate beneath the skin, causing large purple-colored bumps.

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16 comments
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Josie says 8 years ago

My mom has been diagnosed with MM on Oct 17th 2016
Her oncologist was saying she is adapting well to the chemo and now all of a sudden it’s spread
She has a mass in her eye and some masses on her stomach and back
The oncolgist is now giving her REV AID
I am seeking for additional information what should I do next
I’m not sure if I’m asking the right questions or where I should seek additional help and or consultation
But how can this happen

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