The Multiple Phases of Multiple Myeloma
- Multiple myeloma is a blood cancer that forms in a specific kind of white blood cell called plasma cells. The first phase of multiple myeloma is MGUS, in which a small amount of cancerous blood cells are present.
- The second phase is called smoldering multiple myeloma. People with smoldering multiple myeloma have higher numbers of cancerous plasma cells in their bone marrow, but they have not experienced symptoms.
- The third phase is multiple myeloma. This is when patients have experienced at least one of the following symptoms: high calcium, kidney failure, anemia, and/or bone lesions.
- Monoclonal gammopathy of uncertain significance (MGUS)
- Smoldering (or asymptomatic) multiple myeloma
- Multiple myeloma
What Is MGUS?
Multiple myeloma starts with a single plasma cell making more copies of itself than it should. This abnormal reproduction can be detected in the bloodstream because of proteins that are secreted through the process.
Read MoreMost people with this condition do not develop multiple myeloma–the risk is about 1% per year. For most people living with MGUS, the condition requires regular check ups to make sure that it does not advance.
What Is Smoldering Multiple Myeloma?
People who are diagnosed with smoldering multiple myeloma have more plasma cells in their bone marrow than people diagnosed with MGUS, but they still have not experienced symptoms of myeloma. Smoldering myeloma occurs when a patient has greater than or equal to 10% abnormal plasma cells via bone marrow biopsy.
RELATED: Managing the Symptoms of Multiple Myeloma
There is a higher risk of patients with smoldering multiple myeloma developing multiple myeloma, so this condition requires close monitoring. For the first 5 years following a smoldering multiple myeloma diagnosis, patients have a 10% risk of the condition progressing. For the next five years the risk is 3%, and the risk is 1% a year from then on.
According to Dr. Ulrickson, there is not one solid answer to the question of whether or not people with smoldering multiple myeloma should be treated. "Some ongoing research is looking at whether or not patients with smoldering multiple myeloma need to be treated," he explained. "That’s something you should talk about with your physician."
The standard approach to smoldering multiple myeloma used to be to monitor the condition and wait until there were symptoms of multiple myeloma before treating it. More recent research, however, suggests that there may be benefits to earlier treatment. This is particularly true for people with genetic traits that indicate a greater risk of development to full multiple myeloma.
What Is Multiple Myeloma?
When the cancer begins to damage the body, a patient will be diagnosed with multiple myeloma. People with multiple myeloma have more cancerous cells than people with MGUS and smoldering myeloma. "We usually refer to the CRAB criteria when diagnosing multiple myeloma," Dr. Ulrickson said.
- C for high calcium
- R for renal failure (kidney failure)
- A for anemia (a low red blood cell count)
- B for bone lesions, which can cause pain and lead to fractures
Any of these symptoms can lead to a multiple myeloma diagnosis. A person’s health and the classification of their multiple myeloma will inform the treatment path that doctors recommend.
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