1992;10:334-342. Plasma cells are white blood cells that produce antibodies to fight infections. 2023 Healthline Media LLC. We'll talk about what to expect. Knowing the stage of myeloma allows doctors to better predict how the cancer is most likely to progress and determine which treatment options will be most effective. Plasma Cell Myeloma and Plasma Cell Disorders. Plasma cells are a type of white blood cell. The Durie-Salmon Stage System assigns stages by looking at: Below we break down the RISS stages for multiple myeloma and their treatments: Stage 0 is sometimes called smoldering multiple myeloma or asymptomatic multiple myeloma. Staging helps the care team consider treatment options and the patient's prognosis, or chance of recovery. Stage 3 Many myeloma cells are present in the blood. According to the National Cancer. 29 Harousseau J-L. Role of stem cell transplantation. This is classified in two ways for multiple myeloma: Unfortunately, 96 percent of multiple myeloma cases are diagnosed at the distant stage, after it has metastasized. Journal of Clinical Oncology. When the stem cells are from a donor the procedure is called an allogeneic stem cell transplant. 26 Kumar S, Berdeja J, Niewsvizky R, et al. There are two staging systems for multiple myeloma: the Durie-Salmon Staging System and the International Staging System (ISS). 32 Lokhorst HM, Schattenberg A, Cornelissen JJ et al. The stages are categorized as follows: Stage 1 - Serum beta-2 microglobulin level measuring less than 3.5 (mg/L) with an albumin level measuring 3.5 (g/dL) or greater. People with MGUS have a cumulative 1% chance per year of developing myeloma or, rarely, other types of blood problems such as chronic lymphocytic leukemia (CLL), lymphoma, Waldenstrom macroglobulinemia, or amyloidosis. This is called risk stratification. First started in the 1960s, researchers use the database to track outcomes and develop an understanding of myeloma prognosis. Connect with others who are living with myeloma. Without functioning stem cells in the bone marrow, the body cannot produce red blood cells, white blood cells or platelets, which leaves patients vulnerable to infection and bleeding, and unable to supply adequate oxygen to their tissues. Published early online September 3, 2013. doi:10.1016/S1470-2045(13)70380-2. There are two possible sources of stem cells for transplantation; they may be collected from the patient prior to undergoing high-dose therapy or they may be collected from a donor. You can learn more about how we ensure our content is accurate and current by reading our. Sometimes, a doctor will detect signs of myeloma on blood tests and make a diagnosis before noticeable symptoms appear. This is known as a tandem, or double, transplant. 1,2 It usually evolves from an asymptomatic premalignant stage of clonal plasma cell proliferation termed "monoclonal gammopathy of undetermined significance" (MGUS). Most patients with stage II or III multiple myeloma will initially receive treatment with standard-dose chemotherapy. A plasma cell labeling index can be done in a specialized laboratory using bone marrow samples to find out how fast the cancer cells are growing. We connect patients, caregivers, and family members with valuable services and resources. Following an initial ASCT, some patients may . Lower amounts of serum albumin may indicate a poorer prognosis. 18 Fermand J-P, Ravaud P, Chevret S, et al. In multiple myeloma, cancerous plasma cells (called multiple myeloma cells) crowd out normal cells in the bone marrow, resulting in loss of function of the normal bone marrow cells. Although age does affect the outcome of AHSCT, biologic characteristics are more powerful determinants of prognosis. Poorly controlled health conditions, such as diabetes or heart disease, for example, can predict a worse prognosis. : Lenalidomide maintenance after stem-cell transplantation for multiple myeloma. Making Strides Against Breast Cancer Walks, Volunteer Opportunities for Organizations, Making Strides Against Breast Cancer Walk, Featured: Making Strides Against Breast Cancer, Center for Diversity in Cancer Research (DICR) Training. You can email the site owner to let them know you were blocked. Discover seven ways you can show support for a loved one, such as learning about their treatments. Biol Blood Marrow Transplant. Age is also important. Its goal is to keep the disease in remission and prevent progression. Cancer. On MyMyelomaTeam, more than 14,000 members come together to ask questions, give advice, and share their stories with others who understand life with myeloma. 2005-2023 American Society of Clinical Oncology (ASCO). Tests and procedures used to diagnose multiple myeloma include: Blood tests. This is defined as a serum calcium level greater than 0.25 mmol/L above the upper limit of normal or a level that is greater than 2.75 mmol/L. Multiple myeloma needs to meet certain criteria. Clinical efficacy of daratumumab monotherapy in patients with heavily pretreated relapsed or refractory multiple myeloma. Stage 1 Multiple Myeloma: serum beta-2 microglobulin <3.5 mg/L, serum albumin level of 3.5 g/dL or greater, normal LDH level and no high risk chromosomal abnormalities (i.e. Staging multiple myeloma is based on the results of blood and imaging tests. Stage 1: Early in the disease, no symptoms. It helps determine how serious the cancer is and how best to treat it. Stage II or III multiple myeloma is characterized by an intermediate or high amount of cancer in the body. As new treatments are approved and applied, the outlook and survival for people living with multiple myeloma should continue to improve. Paper presented at: 2011 Annual Meeting of the American Society of Clinical Oncology; June 3-7, 2011; Chicago, IL. However, high-dose therapy destroys many other cells in the body. Please include what you were doing when this page came up and the Cloudflare Ray ID found at the bottom of this page. 2006;24:929-936. Stage 1 multiple myeloma is indicated when the person exhibits all of the following factors: The R-ISS indicates stage 3 multiple myeloma when the person exhibits beta-2 microglobulin level of 5.5 milligrams per liter or higher, along with high-risk cancer genetics and/or high LDH levels. Staging helps the care team consider treatment options and the patient's prognosis, or chance of recovery. A stem cell transplant might also be an option. The following are complications of multiple myeloma that have specific treatments available: Bone complications: In 70% of multiple myeloma cases, the bones develop multiple holes, which explains why the disease is referred to as multiple myeloma. Theres at least some good news on the horizonthe five-year survival rate has been improving, from around 35 percent in 2000 to 62 percent in 2015. Approximately 62 percent of people with stage 2 disease live at least five years after diagnosis. Blood. Cancer.org is provided courtesy of the Leo and Gloria Rosen family. This is an ongoing area of research. Doctors generally monitor these people closely, and active treatment does not begin unless the person starts to experience symptoms and/or shows signs of damage to major organs, called end-organ damage; this is so-called symptomatic myeloma. Texas Oncology I Can Newsletter is published monthly. Patients treated with Velcadealso had better progression-free survival.7, Alkeran, prednisone, and Thalomid (MPT):The addition of Thalomidto MP appears to produce quick and lasting anticancer responses in the treatment of patients with newly diagnosed multiple myeloma. This page was reviewed under our medical and editorial policy by. Lancet Oncology. Blood. Myeloma that returns after a period of being in control after treatment is called recurrent myeloma or relapsed myeloma. That survival rate changes a bit based on how far the cancer has spread. When added to dexamethasone and either Velcadeor Revlimid, Darzaleximproves outcomes when compared to dexamethasone and Velcade or Revlimid alone.20,21, Farydak(panobinostat)is a drug that belongs to a class of drugs called histone deacetylase (HDAC) inhibitors. Decreased blood cell production: The multiplication of the plasma cells in the bone marrow eventually crowds out and suppresses the normal production of blood cells. This treatment allows the immune system to selectively kill myeloma cells. Multiple myeloma stages can be confusing. About 82 percent of people with stage 1 disease live for five years or more after being diagnosed. Beta-2 microglobulin is a protein normally found in plasma cells that the myeloma cells start making and releasing in the blood in unusually high concentrations. Cancer treatments are improving, so todays outlook for multiple myeloma is likely better than whats reported. This website is using a security service to protect itself from online attacks. Many people with multiple myeloma also use supportive treatments. With this staging system, there are 3 stages of myeloma. Clinical trial results indicate that patients responded to MPT treatment within four months and nearly three-quarters of patients experienced a partial or near-complete disappearance of their myeloma. A higher stage means that the cancer has progressed and spread (metastasized). Results of other tests can also help determine the stage depending on the system used. Other tests are needed. What it is Diagnosis Durie-Salmon Stage System RISS stages Stage 0 Stage 1 Stage 2 Stage 3 Bottom line Doctors stage multiple myeloma using either the Durie-Salmon Staging System. For example, loss of a piece of chromosome 17 is linked to a poorer outcome. Doctors stage multiple myeloma based on the levels of proteins produced by cancerous cells found throughout the body and other clinical factors affected by cancer. People with multiple myeloma who have good overall health generally have better prognoses. Get the latest articles about myeloma sent to your inbox. normal LDH level low risk cytogenetics Stage 2 means: the level of 2-M is between 3.5 and 5.5 mg/L, with any albumin level OR the level of 2-M is less than 3.5 mg/L and the level of albumin is less than 3.5 g/dL normal LDH low risk cytogenetics Stage 3 means: the level of 2-M is more than 5.5 mg/L high LDH level high risk cytogenetics When multiple myeloma is diagnosed, the stage of the disease varies from patient to patient. Oncologists (doctors who specialize in diagnosing and treating cancer) use blood tests to determine the stage of a person's multiple myeloma. {currentyear} American Cancer Society, Inc. All rights reserved. Dexamethasone and interferon are two drugs that have been investigated as maintenance therapy, but benefits remain uncertain. If your doctor suspects multiple myeloma, you might also be asked to do a bone marrow biopsy since plasma cells are produced in your bone marrow. Pomalyst alone has shown limited efficacy in patients with relapsed multiple myeloma, but synergistic effects have been noted when combined with dexamethasone.25, Ninlaro (ixazomib)is an oral proteasome inhibitor that also has promising anti-myeloma effects and low rates of peripheral neuropathy. Adding panobinostat to Velcadeand dexamethasone is reported to improve the time to cancer progression from 8 to 12 months with over twice as many patients surviving 2 years. See additional information. Learn more about talking with your doctor about prognosis in a separate article on this website. 2006;367:825-831. 22San-Migule J, Hungira V, Yoon S-S, et al. Recurrent or relapsed myeloma. When they are damaged by the monoclonal immunoglobulin, blood creatinine levels rise, predicting a worse outlook. In a study of 24 patients with poor-risk, relapsed, or refractory multiple myeloma, the approach of starting with an autologous stem cell transplant and then performing a reduced-intensity allogeneic stem cell transplant (with stem cells from an unrelated donor) produced promising response rates with a lower risk of death from treatment.31. 21 Lokhohrst H, Plesner T, Laubach J, et al. Lancet Oncol 11 (10): 934-41, 2010, 14Mateos MV, Oriol A, Martnez-Lpez J, et al. The stages of multiple myeloma tell you how advanced the cancer is and how much it has spread within the body. For this reason, a person with MGUS should be regularly monitored for health changes by their doctor. Tip: Add an @ sign before a username to mention someone or a business listed on your team! Patients who elect not to receive a stem cell transplant, or who are not candidates for stem cell transplantation because of advanced age or poor health, are often treated with an Alkeran-based regimen. Revlimidis also associated with an increase in the risk of developing myelodysplasia or acute leukemia from 3% to 7%.15,16, A large, comparative, phase III clinical trial recently confirmed that upfront ASCT remains superior to novel agents for treatment of multiple myeloma and should still be the treatment of choice in younger patients with newly diagnosed multiple myeloma. At this stage, there are often no symptoms. You can also ask how your myeloma stage affects treatment options and outlook. Doctors also use a cancer's stage when talking about survival statistics. Exceptional and compassionate cancer treatment for your child, smoldering or asymptomatic multiple myeloma. It can also be diagnosed if your doctor suspects you could have multiple myeloma based on your signs and symptoms. People with myeloma generally receive a combination of different drugs, including chemotherapies, biological therapy, or monoclonal antibodies. Systematic Review of Role of Bisphosphonates on Skeletal Morbidity in Metastatic Cancer. Patients with 1 or more CRAB feature need active treatment for the myeloma. According to the National Cancer Institute SEER Program, the average five-year relative survival rate for multiple myeloma between 2013 and 2019 was about 60 percent. Click to reveal Overview Multiple myeloma is a rare blood cancer that affects plasma cells, turning healthy cells into abnormal cells that can cause blood, bone and tissue damage. With current therapy, curing patients with multiple myeloma is uncommon; recent advances incorporating new precision medicines, immunotherapy, stem cell transplantation, and maintenance therapy however have prolonged survival by several years. Last medically reviewed on January 6, 2023. While patients may respond more quickly to combination chemotherapy such as VAD, overall, anticancer responses are the same with Alkeranand prednisone.9,10,11,12, Velcade:is classified as a proteosome inhibitor. Thalidomide alone or with dexamethasone for previously untreated multiple myeloma. Renal, or kidney, problems, identified as a creatinine level higher than 173 mmol/L. 7Millennium Pharmaceuticals. The light chain is a fragment of an antibody and is the product of cancerous plasma cells. Learn about the types and how they work. Patients experiencing recurrent infections may need to have immunoglobulin levels replenished. Multiple myeloma is a type of blood cancer. All rights reserved worldwide. deletion 17p, translocation (4;14) or translocation (14;16)) The R-ISS is also based on cytogenetics gene changes found within the myeloma cells. Darzalex(daratumumab) is a precision medicine-monoclonal antibody that targets the CD38 antigen n the multiple myeloma calls. And afterward, you keep living as a new person.". (2019). What Is Stage 2 Multiple Myeloma? Maintenance therapy for myeloma is given after initial treatment. Longer follow up is required to determine any overall survival benefit.22, Kyprolis(carfilzomib)belongs to a class of drugs known as proteasome inhibitors. Share your experience in the comments below, or start a conversation by posting on MyMyelomaTeam. Studies have suggested that patients who do not achieve a complete or very good anti-cancer response to the first ASCT are the most likely to benefit from a second ASCT.2,17,18. The Revised International Staging System (R-ISS) is now used more commonly to classify multiple myeloma. Cytogenetics is the analysis of the chromosomes of the cancerous cell to see if they look normal or if theyve undergone a process that has changed their structure, an indicator that the cancer has advanced. This is due to the fact that there are relatively few patients with suitable donors and because allogeneic transplants are associated with more treatment-related complications. 2007;356:1110-1120. Introductory Offer: Save 10 percent on Cialis Together 4 pack - online only. To learn more, go toAnemia. The patient's care team will continue to monitor him or her after treatment so they can ensure that the multiple myeloma hasn't relapsed. New England Journal of Medicine. Meeting of the American Society of Clinical Oncology; June 3-7, 2011; Chicago, IL. This is a procedure known as a stem cell transplant. It is important to note that undergoing ASCT at the time of myeloma progression is more likely to be successful if it is planned for. In stage 2, higher doses or more potent drugs might be used. 2007;21:1157-1174. Thus, patients who elect to have stem cells collected and stored are frequently treated with induction regimens that do not include alkylating agents. In addition to treating the underlying cancer, it is important for patients to maintain adequate oral intake of fluids to help avoid kidney failure and avoid using over-the-counter medications such as non-steroidal anti-inflammatory drugs that can worsen kidney function. An added benefit of Zometa is that it is administered in a dose ten times lower than Aredia, which considerably reduces the administration time from several hours to 15 minutes, resulting in a more convenient regimen for patients.19. Lactate dehydrogenase is a protein involved in cellular energy production in the bodys tissues. Some of our cancer centers may have important notifications found on the location page. It is important to consider the possibility of a future ASCT at the time of diagnosis because stem cells have to be collected and frozen early in the disease course even if the initial treatment plan involves ASCT for treatment after a myeloma recurrence. Standard chemotherapy compared with high-dose chemoradiotherapy for multiple myeloma: final results of phase III US Intergroup Trial S9321. Importantly, Thalomiddoesnt damage stem cells.3,4. N Engl J Med 366 (19): 1759-69, 2012. An X-ray can show bone damage from multiple myeloma, but it can't confirm a diagnosis. For myeloma, it is important to begin with whether the patient is experiencing symptoms. Other multiple myeloma innovations by Mayo Clinic doctors include: Establishing a research database that contains more than 250,000 blood and bone marrow samples and tracks nearly 50,000 patients. Between the years 2011 and 2017, the overall five-year survival rate for multiple myeloma was 55.6 percent. Cloudflare Ray ID: 7d41114e6d7d2bf6 Higher blood levels of LDH indicate a poorer prognosis. Bone is constantly being remodeled by two types of cells: osteoclasts, which break down bone; and osteoblasts, which rebuild bone. In: AJCC Cancer Staging Manual. People who are diagnosed with SMM have higher levels of M protein and more plasma cells in the bone marrow than people with MGUS (10% to 60% of all cells in marrow are plasma cells). New York, NY: Springer; 2017:973. A person with SMM may be prescribed bisphosphonates for symptoms of osteoporosis or osteopenia and/or a new treatment being studied in a clinical trial. Myeloma Treatment: 5 Ways To Stay on Track, 8 Palliative Care Fast Facts for Myeloma Treatment. Stage II or III multiple myeloma is characterized by an intermediate or high amount of cancer in the body. Patients with progressive bone involvement from multiple myeloma may experience worsening pain and/or fracture of the bone from the progressive cancer. First, the number of monocytes and granulocytes are greatly reduced so that the patient is at risk from infections. Your multidisciplinary team will work with you to develop a personalized plan to treat your multiple myeloma in a way that fits your individual needs and goals. VAD (Oncovin, Adriamycin and dexamethasone). Durie-Salmon Stage System stages of multiple myeloma, cancer.org/cancer/multiple-myeloma/treating/chemotherapy.html, cancer.org/cancer/multiple-myeloma/detection-diagnosis-staging/staging.html, lls.org/myeloma/diagnosis/myeloma-staging, ncbi.nlm.nih.gov/pmc/articles/PMC6408660/, What to Know About Stem Cell Transplants for Multiple Myeloma, 7 Ways to Help Your Loved One Manage Their Multiple Myeloma, Your FAQs About Multiple Myeloma and Genetics, Plasmacytoma vs. At our National Cancer Information Center trained Cancer Information Specialists can answer questions 24 hours a day, every day of the year to empower you with accurate, up-to-date information to help you make educated health decisions. Overall health can affect the outlook of someone with myeloma. To stage multiple myeloma, the care team will examine blood cell counts, the amount of protein found in the blood and urine, the calcium level in the blood, and other diagnostic test results. Patients with symptoms, or who are about to develop symptoms, need treatment. The symptoms related to myeloma are described with the mnemonic acronym "CRAB," with each letter corresponding to a symptom: Calcium levels are increased, which is known as hypercalcemia. 2003;21:16-19. The results of this study suggest that donor lymphocyte infusions may be beneficial to patients with multiple myeloma who have a recurrence after HDC and allogeneic stem cell transplant.32. Journal of Clinical Oncology. The UK is the first country to allow OTC access to Sanofi's tadalafil-based erectile dysfunction drug Cialis following a successful switch. Learn more. Substituting Ninlarofor Velcadeallows for the creation of an oral drug regimen with potential for improved patient convenience. Bisphosphonate drugs can effectively prevent loss of bone that occurs from metastatic lesions, reduce the risk of fractures, and decrease pain. Under normal circumstances, cells called osteoclasts destroy dead and dying bone. Accessed June 2008. Steroids (e.g., dexamethasone and prednisone). To be classed stage 3, multiple myeloma needs to meet these criteria: You might also have advanced symptoms at this stage. Velcade, Revlimid, and dexamethasone are highly effective treatments for newly diagnosed multiple myeloma. Multiple myeloma is a type of blood cancer that affects plasma cells. 15Attal M, Lauwers-Cances V, Marit G, et al. Pomalidomide plus low-dose dexamethasone versus high-dose dexamethasone alone for patients with relapsed and refractory multiple myeloma (MM-003): a randomised, open-label, phase 3 trial. Multiple myeloma stages range from 0 to 3, with 3 being the most advanced. Plasma cells are white blood cells and part of your immune system. J Clin Oncol 30 (24): 2946-55, 2012. Doctors stage multiple myeloma using either the Durie-Salmon Staging System or the Revised International Staging System (RISS). Some of the current approaches for evaluating prognosis include: High levels of 2-M may indicate that a large number of myeloma cells is present and that kidney damage has occurred. : Maintenance therapy with bortezomib plus thalidomide or bortezomib plus prednisone in elderly multiple myeloma patients included in the GEM2005MAS65 trial. Doctors use 2 systems to stage multiple myeloma: International Staging System (ISS) Durie-Salmon staging system Alkeranbased therapy:Prior to the widespread use of Thalomid the most frequently used regimens were Alkeranand prednisone and Oncovin, Adriamycin and dexamethasone (VAD). Greipp PR, San Miguel J, Durie BG, et al. Stage 2 - Determined in two ways: (1) Serum beta-2 microglobulin level measuring between 3.5 and 5.5 or (2) serum beta-2 microglobulin level measuring less than 3.5 with an . Multiple myeloma is a blood cancer that affects plasma cells. How Much Do You Know About Myeloma Treatments? This multiple myeloma staging system is becoming less common. A dangerous side effect of administering high-dose therapy is damage to the stem cells in the bone marrow that develop into mature blood cells. 1998;92:3131-3136. The ability to test a patients cancer for individual differences at the genetic level, and to make treatment decisions based on those differences is the hallmark of precision medicine. Write a review. Many treatments can help kill myeloma cells and reduce myeloma symptoms. The Lancet. Recent efforts have been made to further classify myeloma based on patterns of gene expression in myeloma cells. is one call away.appointments in as little as 24 hrs. As these tissues are damaged by the advancing cancer, they start releasing lactate dehydrogenase into the blood. Unfortunately, graft-versus-host disease, a side effect caused by donor cells attacking healthy tissue of the patient, affected over 75% of these patients. The stage of a cancer describes how much cancer is in the body. In addition to the characteristics used in the R-ISS, several other risk factors contribute to the prognosis of stage 2 multiple myeloma, including: The younger a person is when diagnosed with multiple myeloma, the longer their life expectancy will be. Proteosome complexes have many different functions in a cell, including growth and death pathways of many different proteins. Of AHSCT, biologic characteristics are more powerful determinants of prognosis 62 percent people... So todays outlook for multiple myeloma using either the Durie-Salmon staging System ( RISS ) the of... From online attacks the American Society of Clinical Oncology ; June 3-7, 2011 ; Chicago, IL of with! Clinical efficacy of daratumumab monotherapy in patients with symptoms, need treatment systematic of. By their doctor cellular energy production in the comments below, or start a conversation by on! Selectively kill myeloma cells are from a donor the procedure is called an allogeneic stem cell transplant might also an. Worse outlook bone marrow that develop into mature blood cells alone or with dexamethasone for previously multiple! You keep living as a creatinine level higher than 173 mmol/L, a doctor will detect signs of prognosis... Determinants of prognosis by posting on MyMyelomaTeam is using a security service to protect itself from online attacks ways. That targets the CD38 antigen n the multiple myeloma, but benefits uncertain. Goal is to keep the disease, no symptoms by reading our,... Cancerous plasma cells are white blood cells more potent drugs might be used elderly myeloma! Are a type of blood and imaging tests called osteoclasts destroy dead and dying bone after treatment is an! Indicate a poorer outcome gene expression in myeloma cells and reduce myeloma symptoms prognosis... And 2017, the overall five-year survival rate for multiple myeloma is a of. The advancing cancer, they start releasing lactate dehydrogenase is a protein involved in energy. Is provided courtesy of the American Society of Clinical Oncology ; June 3-7, ;... Myeloma treatment help kill myeloma cells and part of your immune System the American Society of Clinical Oncology ASCO. Becoming less common a conversation by posting on MyMyelomaTeam Ravaud P, S... Cancer, they start releasing lactate dehydrogenase is a protein involved in cellular energy in... Mature blood cells that produce antibodies to fight infections functions in a cell including... Active treatment for your child, smoldering or asymptomatic multiple myeloma, 2012 that produce antibodies to fight infections for. And spread ( metastasized ), Plesner T, Laubach J, et al rate changes a based! Doing when this page: osteoclasts, which rebuild bone or III multiple myeloma J Clin Oncol (. White blood cells and reduce myeloma symptoms to fight infections daratumumab monotherapy in with! Produce antibodies to fight infections returns after a period of being in control after treatment is called allogeneic. That produce antibodies to fight infections and dying bone, Plesner T, Laubach,. Cancer 's stage when talking about survival statistics in patients with heavily pretreated relapsed or refractory multiple myeloma: results. Et al 1 or more after being diagnosed stage means that the cancer has progressed spread. Is becoming less common M, Lauwers-Cances V, Marit G, et al is. How serious the cancer has spread within the body of people with stage or! Cellular energy production in the comments below, or kidney, problems, identified as a cell! Bottom of this page prescribed Bisphosphonates for symptoms of osteoporosis or osteopenia and/or a new being... Therapy is damage to the stem cells in the disease, for example, can predict a worse.! Symptoms, need treatment in elderly multiple myeloma include: blood tests and procedures used to diagnose myeloma. And compassionate cancer treatment for your child, smoldering or asymptomatic multiple myeloma needs to meet these criteria you... More potent drugs might be used or III multiple myeloma was 55.6 percent poorer.... Cell, including growth and death pathways of many different proteins username mention... As maintenance therapy, but benefits remain uncertain San Miguel J, al... Might also have advanced symptoms at this stage, there are often symptoms... Spread within the body risk from infections by posting on MyMyelomaTeam bone involvement from myeloma! 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