Understanding Multiple Myeloma Prognosis by Age and Stage

Understanding the Multiple Myeloma Prognosis

Receiving a diagnosis of multiple myeloma can be scary and overwhelming. One of the first things patients want to know is their prognosis - what is the normal progression and survival statistics for this disease? Understanding outlook based on multiple myeloma prognosis by age and other factors can help patients and doctors make informed decisions about the best treatment options available.

What Impacts Multiple Myeloma Life Expectancy?

According to statistics, the average life expectancy for people with multiple myeloma is about 5 years from the time of diagnosis. However, many factors affect an individual patients prognostic outlook:

• Age - Younger patients, on average, live longer with myeloma than elderly patients.
• Overall health People in otherwise good health tend to have better prognoses.
• Disease stage Early stage disease carries a more positive prognosis than later, advanced stages.
• Genetic features Certain myeloma subtypes, like high-risk cytogenetics, reduce outlook.
• Response to treatment How well treatment works for you improves your long-term outlook.

Multiple Myeloma Prognosis by Age Brackets

In general terms, age significantly influences average life expectancy for multiple myeloma. Some prognosis statistics by age include:

• Age 40 and under - 7 year median survival
• Age 41-60 years old - 5 year median survival
• Age 61-70 years old - 4 year median survival
• Over age 70 - 2 year median survival

However, these are very general estimates looking at broad population statistics. Many individual patients beat these outlooks, especially with newer treatments available.

How Multiple Myeloma Is Staged

Staging multiple myeloma gives doctors a standard measurement for categorizing the disease from early to more advanced stages. Its one of the strongest indicators for predicting patient prognosis.

International Staging System (ISS)

The ISS divides myeloma into 3 stages based on 2 laboratory blood markers:

• Stage I - Serum beta-2 microglobulin is less than 3.5 mg/L and serum albumin is 3.5 g/dL or more.
• Stage II - Not meeting criteria for either stage I or III disease.
• Stage III - Serum beta-2 microglobulin is 5.5 mg/L or over and serum albumin is under 3.5 g/dL.

The ISS stages correlate with these general survival estimates:

• Stage I - 62 month median survival
• Stage II - 44 month median survival
• Stage III - 29 month median survival

Revised International Staging System (R-ISS)

The Revised ISS adds genetic factors into the equation for more precise prognostic staging:

• Stage I - ISS Stage I and standard-risk cytogenetics by FISH
• Stage II - Not ISS Stage I or III and standard-risk cytogenetics
• Stage III - ISS Stage III and either high-risk genetics or high lactase dehydrogenase (LDH) levels

The median overall survival estimates by R-ISS stage are:

• Stage I - 82 months
• Stage II - 62 months
• Stage III - 40 months

Factors That Worsen Prognosis

Some multiple myeloma disease features make the prognosis significantly worse. Being aware of these risk factors gives patients and doctors more personalized information to guide treatment choices.

High-Risk Genetic Mutations

Cytogenetic testing by fluorescent in situ hybridization (FISH) detects high-risk genetic mutations like:

• del(17p)
• t(4;14)
• t(14;16)
• t(14;20)
• 1q amplification

Having one or more of these changes indicates high-risk disease with more rapid progression and shorter survival durations, even with treatment.

Elevated LDH

High blood serum lactate dehydrogenase (LDH) correlates to having more advanced, faster growing disease. Elevated LDH marks high tumor burden and can negatively impact Stage III R-ISS prognosis.

Plasma Cell Leukemia

In rare cases, multiple myeloma cells proliferate rapidly and spill over from the bone marrow out into peripheral blood circulation. This plasma cell leukemia represents very aggressive disease with reduced outlook.

Extramedullary Disease

Extramedullary myeloma meaning plasma cells growing outside the bone marrow cavity also lessens prognosis slightly since these areas are more difficult to treat.

Age Over 75

Elderly multiple myeloma patients over 75 years old have higher treatment-related risks, more aggressive development, and lowered survival - especially when other high-risk factors are also present.

Outlook by Line of Treatment

Another consideration for multiple myeloma prognosis by age brackets and stage includes outlook depending on phases of treatment. In general, survival durations correlate with how many lines of therapy are or will be utilized:

• At diagnosis - The average life expectancy as discussed based on age and disease stage.
• After frontline treatment - Most newly diagnosed myeloma patients undergo induction chemo and stem cell transplant plans to achieve initial remission and extended survival, usually at least 2 years or more.
• At first relapse After relapse following frontline therapy, second line treatments produce another remission period, typically 1 to 3 years long depending on the regimen.
• At second relapse and beyond Some patients undergo 3rd, 4th or later lines of advanced treatments, though durations tend to progressively shorten with each successive relapse.

In a sense, outlook can be viewed as a moving target - the prognosis may change based on your disease features, how you respond to treatments over time, and what next-step options remain viable if and when relapses occur down the road.

Living with Multiple Myeloma - Survivorship Care Plan

Managing side effects, emotional ups and downs, and lifestyle changes are all important parts of the myeloma journey as well. Working closely with your oncologist to implement a Survivorship Care Plan can help you plot out a blueprint to enhance wellness and cope on both a physical and emotional level at every stage after diagnosis. Key elements often include:

Follow Up to Monitor Disease Status

Routine blood work, bone marrow biopsies, and imaging at scheduled intervals spot if and when myeloma relapse occurs for rapid treatment implementation to stay ahead of the disease.

Screenings for Secondary Cancers

Myeloma survivors get certain unrelated cancer screenings earlier and more frequently due to having elevated risk from prior treatments.

Rehabilitation Services

Referral for physical therapy, occupational therapy, speech therapy or mental health services targets specific problems you experience to help you functionally thrive day-to-day.

Symptom Management Therapies

Palliative care specialists aid with ongoing fatigue, neuropathy, pain, or other issues through medications, nutrition advice, physical/mind-body modalities and more to optimize quality of life.

Wellness/Prevention Programs

Guidance on diet, exercise, stress reduction techniques and limiting other health risk factors empowers you to directly support your own health and ability to manage myeloma optimally long-term.

By taking advantage of these resources, you play an active role in working to extend your prognosis and feel your best while balancing life with multiple myeloma.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.