Stage 3 Multiple Myeloma: A Patient’s Guide to Treatment and Outlook

Receiving a diagnosis of stage 3 multiple myeloma is a significant life event, but medical advancements in the last decade have transformed the outlook for this condition. This guide is designed to help you understand the clinical landscape of your diagnosis and prepare you for detailed discussions with your oncology team.

Defining Stage 3 Multiple Myeloma and the R-ISS

Multiple myeloma is a cancer of the plasma cells, a type of white blood cell found in the bone marrow. In a healthy body, plasma cells produce antibodies to fight infection. In myeloma, these cells grow out of control and produce an abnormal protein called M protein, which can damage the bones, kidneys, and immune system.

The Revised International Staging System (R-ISS) is the standard for staging. Stage 3 is the most advanced stage and is determined by three factors:

• High levels of beta-2 microglobulin in the blood.
• High levels of lactate dehydrogenase (LDH).
• The presence of "high-risk" genetic abnormalities within the cancer cells (detected through FISH testing).

While a stage 3 diagnosis sounds daunting, it primarily serves as a roadmap for your doctors to determine how aggressively to treat the disease.

For example, in an interview with CURE, multiple myeloma survivor Todd Kennedy shared the journey of his 2017 diagnosis and subsequent treatment. strategies. “Myeloma is complex, and an expert can truly change the course of your care.”

Diagnosis: The CRAB Criteria and Biomarker

Doctors use the CRAB criteria to diagnose active myeloma and monitor its progression. Your medical team will likely refer to these four indicators:

1. C – Calcium elevation: Excess bone breakdown releases calcium into the blood.
2. R – Renal (kidney) insufficiency: M proteins can clog the kidneys' filtering system.
3. A – Anemia: Overcrowded bone marrow cannot produce enough red blood cells, leading to fatigue.
4. B – Bone disease: Soft spots (lytic lesions) or fractures visible on imaging.

Common Diagnostic Tests

• Bone marrow biopsy: To determine the percentage of plasma cells.
• Imaging (PET/CT or MRI): To identify bone damage or tumors (plasmacytomas).
• Blood and urine tests: To measure M protein and "light chains."

Modern Treatment Options for Advanced Myeloma

Treatment for stage 3 myeloma is typically divided into phases. The goal is to achieve a deep remission, meaning the cancer is undetectable.

Induction Therapy and "Triplet" vs. "Quadruplet" Regimens

This is the first phase. Most patients receive a "triplet" or "quadruplet" therapy, a combination of three or four drugs. Common combinations include:

• Proteasome inhibitors (e.g., bortezomib).
• Immunomodulatory drugs (e.g., lenalidomide).
• Monoclonal antibodies (e.g., daratumumab).
• Corticosteroids (e.g., dexamethasone).

Stem Cell Transplant

If you are "transplant eligible" (based on age and overall health), doctors may recommend an autologous stem cell transplant. Your own healthy stem cells are collected, high-dose chemotherapy is administered to kill remaining myeloma cells, and the stem cells are returned to your body to rebuild your immune system.

Maintenance Therapy

After induction or transplant, patients usually take a low-dose medication (often lenalidomide) long-term to keep the cancer from returning.

Side Effects and Symptom Management

Managing side effects is a priority to maintain your quality of life. Common effects include:

• Peripheral Neuropathy: Tingling or numbness in hands and feet, often caused by proteasome inhibitors.
• Fatigue: Resulting from both the disease (anemia) and the treatments.
• Increased Infection Risk: Myeloma weakens the immune system. You may be prescribed shingles or pneumonia prophylaxis.
• Bone Pain: Often managed with bisphosphonates (bone-strengthening drugs) or radiation.

Always report new or worsening symptoms to your nurse or oncologist immediately. Many side effects can be mitigated with dosage adjustments.

Preparing for Your Consultation: Questions for Your Oncologist

Multiple myeloma is currently considered a chronic, manageable condition rather than an incurable one for many patients. Education is your best tool for advocacy.

Oya Gilbert, a multiple myeloma survivor who was also diagnosed in 2017, echoed these sentiments.

“Bring another set of ears with you to appointments if you can,” Gilbert said during an interview with CURE at the 2025 Annual Blood Cancer Heroes event. “You won’t catch everything, and it’s overwhelming. If no one can come with you, ask permission to record the visit so you can listen back later.

Ask questions. There are no dumb questions. Don’t be afraid to challenge what you’re told or to seek a second opinion. You’re not discrediting your doctor. In cancer care, there are no perfect decisions, only sound ones, and those require information.

Here are examples of some questions to ask your oncologist:

1. What were the specific results of my FISH?
2. Am I considered a candidate for an autologous stem cell transplant?
3. What is our goal for "minimal residual disease" (MRD) status?
4. What supportive care (such as bone-strengthening injections) will I receive?

Your care team is your most valuable resource. Please use this information to ask detailed questions and ensure you are an informed and active participant in all decisions regarding your health.

Editor's note: This article is for informational purposes only and is not a substitute for professional medical advice, as your own experience will be unique. Use this article to guide discussions with your oncologist. Content was generated with AI, reviewed by a human editor, but not independently verified by a medical professional.

References

1. “Understanding Stage 2 Myeloma with Treatment and Next Steps Explained.” CURE, November 16, 2025. https://www.curetoday.com/view/understanding-stage-2-myeloma-with-treatment-and-next-steps-explained
2. “The Sub-Q Therapy That Cut Hours Off Treatment Time.” CURE, November 17, 2025. https://www.curetoday.com/view/the-sub-q-therapy-that-cut-hours-off-treatment-time
3. “Oya Gilbert Urges Self-Advocacy, Emotional Support for Patients With Myeloma.” CURE, January 5, 2026. https://www.curetoday.com/view/oya-gilbert-urges-self-advocacy-emotional-support-for-patients-with-myeloma

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