Myeloma refers to a type of cancer that affects the plasma cells. A type of white blood cell, plasma cells are a part of the immune system that helps fight infections by making immunoglobulins (antibodies). Plasma cells and other blood cells are made in bone marrow, the innermost part of some bones. Bone lesions occur when the abnormal plasma cells overproduce. They can then spread to other bones, causing multiple myelomas, or producing substances that weaken the bone. Stage 3 is the most advanced stage of multiple myeloma and has the highest likelihood of symptoms.

Staging Systems for Myelomas

Among the systems used to determine the stage of multiple myeloma are the International Staging System (ISS) and the Revised International Staging System (R-ISS). Both systems have three stages of multiple myeloma, with stage 1 being the least advanced and stage 3 being the most advanced. Stages are sometimes written with Roman numerals, such as stage I or stage III.

International Staging System

The ISS was developed in 2005 by the International Myeloma Working Group, drawing on data on 10,750 myeloma patients throughout Europe, Asia, and North America from 17 different institutions. The ISS multiple myeloma criteria rely on measuring the levels of beta-2 microglobulin and albumin (each a type of protein found in blood) from the serum — the watery component left over after blood coagulates.

According to the ISS, people with stage 3 myeloma have beta-2 microglobulin levels greater than 5.5 milligrams per liter of serum. The serum albumin is not a part of stage 3 staging.

Revised International Staging System

In August 2015, the International Myeloma Working Group published the R-ISS. The revised system includes a genetic risk assessment using fluorescence in situ hybridization (FISH). It also looks at levels of lactate dehydrogenase (LDH), an enzyme that helps generate your body's energy.

A stage 3 diagnosis of myeloma using the R-ISS requires beta-2 microglobulin levels that are equal to 5.5 milligrams per liter of serum or higher. Additionally, either the FISH test must show a high risk of chromosomal abnormalities or the person must have high LDH levels in their blood. The R-ISS does not take into consideration serum albumin when determining stage 3 multiple myeloma.

Diagnosis of Stage 3 Multiple Myeloma

Many people are asymptomatic in the early stages of myeloma and may be diagnosed during a blood exam for other conditions. Age is the most significant risk factor in developing myeloma. Most people with stage 3 myeloma have cancer cells that have typically invaded more than one site in the body. This means the person is most likely to have symptoms such as bone pain, fatigue, increased infections, back pain, and changes in posture.

To diagnose and determine the stage of a person’s multiple myeloma, a doctor will run blood tests to measure their levels of beta-2 microglobulin, serum albumin, and calcium in the blood. They will also check for low red blood cell counts (a condition known as anemia). Typically, the blood tests will be followed up with imaging tests, such as an X-ray, an MRI scan, or a positron emission tomography (PET) scan, which are used to view abnormalities and bone damage.

Learn more about the diagnosis of multiple myeloma.

Treatment of Stage 3 Multiple Myeloma

The treatment plan for stage 3 multiple myeloma will include a combination of therapies to help increase survival rates. Treatment options include the following therapies:

• Antibodies
• Chemotherapy
• Immunomodulatory drugs
• Novel mechanism of action drugs
• Proteasome inhibitors
• Radiation therapy
• Stem cell transplants
• Steroids
• Surgery

Many plans for cancer treatment are personalized to treat a person’s specific symptoms and slow the progress of cancer — while minimizing the negative side effects. As new multiple myeloma treatments are approved, survival rates continue to improve for people with myeloma.

Learn more about treatments for multiple myeloma.

Outlook for Stage 3 Multiple Myeloma

In predicting a person’s disease prognosis (outlook), a doctor will take into consideration the stage of the multiple myeloma as well as the person’s age and overall health. The following prognostic factors are associated with a favorable outlook:

• An earlier stage of cancer (stage 1 or stage 2)
• Younger age
• Lower serum beta-2 microglobulin levels, which indicate fewer myeloma cells
• Lower LDH levels, which indicate lower tumor burden
• Higher serum albumin levels
• Higher levels of creatinine, a waste product produced by the kidneys and used to determine renal function
• Lack of cytogenetics (chromosome changes)
• Overall performance, in that people who are in better health and are more active tend to have a better prognosis

Although many of the factors above are associated with earlier stages of multiple myeloma, people with stage 3 myeloma can have a positive outlook if they are generally healthy and still have high kidney function. The tumor’s cytogenetics also play a role.

Early detection can increase survival rates. It is important to consult an oncologist (a doctor who specializes in cancer) shortly after myeloma diagnosis to increase the chances of survival of stage 3 myeloma.

Survival Rates for Multiple Myeloma

The American Cancer Society determines the survival rate for cancers by quantifying what percentage of people with the same type and stage of cancer are alive five years after their diagnosis.

The five-year survival rate for people diagnosed with multiple myeloma is 53.9 percent, which means that if 100 people are diagnosed with multiple myeloma, about 54 are likely to still be alive five years later. The survival rates are based on groups of people and should be interpreted very carefully. A particular person’s chance of survival will be impacted by the prognostic factors, the stage at the time of diagnosis, and treatments.

The survival rates are calculated using the information from people who were diagnosed at least five years ago. As new treatments are approved and implemented, the survival rates continue to increase.

Talk With Others Who Understand

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

Have you been diagnosed with multiple myeloma? Share your experience in the comments below, or start a conversation by posting on your Activities page.