Multiple myeloma occurs when certain white blood cells, called plasma cells, become abnormal and multiply out of control. Plasma cells are a part of the immune system. They make proteins called antibodies that help fight infection.

When a doctor diagnoses someone with multiple myeloma, they assign a stage based on the results of blood tests, a bone marrow biopsy, and imaging studies. There are three stages of multiple myeloma, referred to as stage 1, stage 2, and stage 3. (Stages are also sometimes rendered with Roman numerals, i.e., stage I, stage II, and stage III.) Doctors use staging information to guide treatment decisions.

Understanding Multiple Myeloma Staging

Multiple myeloma staging differs from that of most other cancers. In solid tumors, such as lung cancer or breast cancer, staging typically reflects the tumor’s size, how much it has spread, and whether it has metastasized (spread to other areas of the body). However, multiple myeloma is a blood cancer that originates in the bone marrow and affects the bloodstream. This means that multiple myeloma is, by its nature, systemic and widespread.

Staging for multiple myeloma focuses on factors such as bone damage, levels of a marker called beta-2 microglobulin (B2M), and the presence of abnormal protein levels. It’s important to note that, unlike staging for solid tumors, multiple myeloma staging provides less direct information about disease prognosis (outlook).

What Is Stage 1 Multiple Myeloma?

Stage 1 multiple myeloma is the earliest and least advanced stage of the disease. In people with stage 1 myeloma, the cancer progresses slowly, and the number of myeloma cells remains low. For stage 1 myeloma, doctors may recommend monitoring the condition with regular check-ups and testing, rather than starting treatment right away.

International Staging System

In 2015, the system for staging myeloma was updated with the Revised International Staging System (R-ISS). This R-ISS has largely replaced the older Durie-Salmon Staging System.

The R-ISS measures the levels of three proteins found in the blood: albumin, beta-2 microglobulin, and lactate dehydrogenase (LDH). Lower levels of albumin and higher levels of B2M and LDH indicate more advanced or worsening myeloma. The R-ISS also incorporates cytogenetic testing, which identifies specific genetic changes in myeloma cells.

According to the R-ISS, stage 1 multiple myeloma has the following features:

• Albumin levels of 3.5 grams per deciliter or higher — Albumin is a protein produced by the liver that helps maintain fluid balance in the blood vessels and transports nutrients and hormones to tissues throughout the body.
• Beta-2 microglobulin levels less than 3.5 milligrams per liter — B2M is a protein that can be elevated with blood cancers and bone marrow cancers.
• Normal levels of lactate dehydrogenase — LDH is an enzyme involved in energy production within cells.
• No high-risk genetic changes

If you have questions about your multiple myeloma stage, your doctor can provide a more detailed explanation of your test results and how your stage was determined.

Related Conditions

Multiple myeloma is related to several other plasma cell disorders, including monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM). These disorders can lead to myeloma in some people. MGUS and SMM are sometimes called precursor stages of multiple myeloma, meaning they are early, precancerous forms of plasma cell disorders that may develop into multiple myeloma.

MGUS is a mild disorder in which abnormal plasma cells are present but aren’t cancerous. People with MGUS have slightly higher levels of plasma cells that produce small amounts of M protein, which can be detected in blood tests. Some people with MGUS develop SMM, an asymptomatic form of myeloma (one that doesn’t cause symptoms) that’s characterized by higher levels of plasma cells and M protein.

People who develop multiple myeloma first experience MGUS and SMM. However, only 1 percent of people with MGUS will develop active multiple myeloma. These conditions are not included in the R-ISS staging of multiple myeloma and are not the same as a diagnosis of active multiple myeloma.

Signs and Symptoms of Stage 1 Multiple Myeloma

Some people with early-stage myeloma may not have any obvious symptoms. As myeloma advances in stage 1, symptoms may develop, including:

• Bone pain
• Extreme tiredness
• Hypercalcemia (high levels of calcium in the blood)
• Anemia (low levels of red blood cells)
• Poor kidney function
• Bone lesions (abnormalities or bone damage) that show up in X-rays
• Frequent infections

If you’re experiencing bone pain or any other symptoms of multiple myeloma, talk to your doctor.

Stage 1 Multiple Myeloma Treatments

Treatment for stage 1 multiple myeloma is based on a person’s signs and symptoms, overall health, personal preferences, and test results. If multiple myeloma is active with symptoms in stage 1, cancer treatment is generally recommended.

Active multiple myeloma is initially treated with a combination of drugs, including chemotherapy, immunotherapy with monoclonal antibodies, and corticosteroids. Because around 85 percent of all people with multiple myeloma develop low bone density and bone lesions, individuals with symptomatic myeloma often receive bisphosphonate drugs or denosumab to treat bone pain and strengthen the bones.

Other treatment options may include:

• Chimeric antigen receptor T-cell (CAR T-cell) therapy
• Radiation therapy
• Bone marrow transplant
• Surgery in some cases

More aggressive treatment plans may be recommended for people with stage 2 or stage 3 (also written as stage II or stage III) disease. People with later-stage multiple myeloma may also benefit from supportive treatments aimed at relieving symptoms.

Always discuss potential treatment side effects with your doctor.

Outlook for Stage 1 Myeloma

Doctors often measure a person’s prognosis using a combination of survival statistics, the overall health of an individual, and the biology of the myeloma cells, which can be evaluated with several different tests.

Staging does not directly correspond to survival rates. The five-year relative survival rate for people with myeloma is 61 percent. Relative survival compares the survival of those with myeloma to people without the disease.

The relative survival rate and life expectancy have steadily improved in recent decades as oncology researchers have learned more about myeloma and developed more effective treatments. People diagnosed with multiple myeloma today may have better outcomes than current data may indicate as treatment continues to advance.

Doctors may consider how many tumors a person has. Currently, the relative five-year survival for people diagnosed with a single localized plasmacytoma (plasma cell tumor) is 79 percent. People who have developed multiple myeloma with multiple tumors have a relative survival rate of 57 percent.

Other factors can also affect prognosis including genetic changes that can occur in myeloma tumors. People who have kidney problems, are older, or have other health conditions often have worse survival rates. If you are interested in learning more about your prognosis, talk to your doctor.

Talk With Others Who Understand

On MyMyelomaTeam, the social network for people living with multiple myeloma and their loved ones, more than 26,000 members come together to ask questions, give advice, and share their stories with others who understand life with myeloma.

Are you living with stage 1 multiple myeloma? Share your experience in the comments below, or start a conversation by posting on MyMyelomaTeam.