Posted on July 23, 2021 Medically reviewed by Mark Levin, M.D.
Article written by Maureen McNulty
If your doctor diagnoses you with multiple myeloma, they may
also estimate your prognosis. Your prognosis, or outlook, describes how likely
it is that your myeloma will progress (get worse). Doctors may use prognosis to
help determine a treatment plan.
Multiple Myeloma Survival Rates
The five-year survival rate for multiple myeloma in the United
States is 55.6 percent. This means
that around 55 out of 100 people will live for five years or more after being
diagnosed with myeloma.
People diagnosed with very early-stage myeloma have better
survival rates. About 4 percent of people are diagnosed when
their myeloma is localized to one small area. This may be called a solitary
plasmacytoma (plasma cell tumor). Around 77.5 percent of people diagnosed with
solitary plasmacytoma live for at least five years after diagnosis.
Survival Rates Are Improving
The five-year survival rate for myeloma has improved in the
past few decades. From 1975 to 2005, myeloma survival rates improved by
about 2 percent every two
years. Since 2005, survival rates have increased even more rapidly.
The discovery of new types of treatments has boosted survival
rates within the past couple of decades. The U.S. Food and Drug Administration
(FDA) has approved several
new drugs for myeloma in recent years. Progress is continuing. In 2020, the FDA
approved three new myeloma drugs and
several new regimens (combinations of medications). Thus far in 2021, the
FDA has approved additional
drugs and regimens, including a new type of cancer treatment that involves
genetically engineering immune cells.
Current five-year survival rates were calculated using data from
people diagnosed from 2011 to 2017. These survival rates don’t take into
account the newest treatment options. People diagnosed with myeloma today may
have a better prognosis than current data suggests.
Prognostic Factors
Survival rates are estimated based on the outcomes of large
groups of people. They don’t tell you what your individual outlook
will be. Your health care team can help you better understand your predicted
outcome using prognostic factors — factors that are linked with a better or
worse outcome. Several prognostic factors can tell you more about your outlook.
Age
Older adults with
multiple myeloma tend to have worse prognosis than do younger adults:
·
Approximately 71.4
percent of people with multiple myeloma who are under the age of 50 live for
five years or more after diagnosis.
·
Around 64.1 percent of
those with the condition who are aged 50 to 64 live at least five years.
·
About 46.5 percent of
people with the condition aged 65 or older live for five years or more.
Performance Status
Doctors use the term “performance status” to describe a person’s
overall well-being. Karnofsky Performance Status Scale and ECOG (which stands for Eastern Cooperative Oncology
Group) Scale of Performance are two performance scales,
designed to measure how well a person functions. People who are better able to complete daily tasks and
are more active are likely to have a positive prognosis.
Remission
When myeloma goes away after treatment, it is known as remission.
A person may experience partial remission —
when cancer improves but doesn’t completely go away — or complete remission, when
all cancer signs disappear. A complete remission does not mean that the disease
may not return. If myeloma quickly goes into complete remission following
treatment, a positive long-term outcome is more likely.
Blood Tests
Certain molecules in the blood can be signs of inflammation,
damage, or cancer. Having high blood levels of
any of the following is linked to a worse prognosis:
·
Beta-2 microglobulin
·
Lactate dehydrogenase
(LDH)
·
Creatinine
·
Calcium
On the other hand, having a high level of albumin protein in
the blood is a sign of a better outcome.
Gene or Chromosome Changes
Doctors may test multiple myeloma cells to identify any changes
to their chromosomes (long pieces of DNA that contain genes). Certain chromosome changes increase a person’s
chances of having a poor outcome:
·
Deletion of all or
part of chromosome 13
·
Deletion of part of
chromosome 17
·
Amplification (copy)
of part of chromosome 1
·
Chromosome
translocations (part of one chromosome breaks off and abnormally attaches to
another) between chromosome 14 and another chromosome
Researchers have also performed studies looking at how individual genes impact prognosis.
Certain sets of genes can be found in cells at low or high levels, leading to a
worse outlook.
Myeloma Stage
Myeloma prognosis is closely linked to myeloma stage. The stage describes how
advanced the myeloma is and helps predict outcomes. People with higher stages
of multiple myeloma have a poor prognosis.
There are two systems often
used to stage multiple myeloma. The Durie-Salmon Staging System determines
stage based on:
·
Levels of hemoglobin,
used to measure anemia (low levels of red blood cells)
·
Calcium levels
·
Bone lesions (tumors)
·
Amount of monoclonal protein or M protein (an
abnormal protein made by abnormal plasma cells)
·
Kidney function (how
well the kidney is working)
A newer system, the Revised International Staging System, relies on gene
changes and levels of beta-2 microglobulin, albumin, and LDH.
Plasma Cell Labeling Index
People who have faster-growing myeloma cells have a
higher chance of having a poor outlook. A test called a plasma cell labeling
index (PCLI) measures how fast myeloma cells divide. A higher PCLI score means
that cancer cells are growing faster.
Serum Free Light Chain
Cancerous plasma cells make abnormal immunoglobulins
(antibodies). Each immunoglobulin is made up of two heavy chain proteins and
two light chain proteins. Cancerous plasma cells often make more light chains than are needed
for making antibodies. Extra light chain proteins can be measured with a test
called a serum free light chain (SFLC) assay.
People with a high SFLC score are likely to have a poor
prognosis. SFLC can also be used to predict prognosis in people who have milder
forms of plasma cell disorders, such as monoclonal gammopathy of undetermined significance (or
MGUS) and smoldering myeloma. People with these
conditions are more likely to develop multiple myeloma if they have a high
SFLC.
Number of Abnormal Plasma Cells
Those who have higher numbers of abnormal plasma
cells in their bone marrow are likely to have a worse disease
course.
Neighborhood
In one study, researchers found that people who lived in lower-income neighborhoods had
a higher chance of having a poor outcome.
Being Treated By a Specialist
As many as 80 percent of
people with myeloma are diagnosed in community hospitals. However, people who
are treated in community hospitals have worse outcomes. Prognoses are better
for people treated in academic hospitals or
in places that are a part of a network of cancer facilities.
Treatment Plan
Certain multiple myeloma treatments have
a higher chance of success. People who have an autologous stem cell transplant — which
uses a person’s own stem cells — are likely to have a better prognosis.
However, stem cell transplants can lead to serious side effects, and the
myeloma usually comes back in a few years. Allogeneic stem cell transplants — which
use stem cells from a donor — can also be used, but they have more potential
side effects. Stem cell transplantation is often not an option for people who
are older or are in worse health. Chimeric antigen receptor T-cell therapy (or
CAR-T cell therapy) is approved in the United States for relapsed or refractory
myeloma.
Other treatments also improve prognosis. Traditionally, people
with multiple myeloma received chemotherapy as a first-line treatment. Recent
studies have found that using newer medications as
a first-line treatment leads to better outcomes.
Talk With Others Who Understand
MyMyelomaTeam is the social network for people with
multiple myeloma and their loved ones. On MyMyelomaTeam, more than 10,000
members come together to ask questions, give advice, and share their stories
with others who understand life with multiple myeloma.
Mark Levin, M.D. is a hematology and
oncology specialist with over 37 years of experience in internal medicine.
Review provided by VeriMed Healthcare Network. Learn more about him here.
Maureen McNulty studied molecular
genetics and English at Ohio State University. Learn more about her here.
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