I have multiple myeloma. Can the doctors tell if I?m going to be OK?

It is always difficult trying to make predictions about the likely outcome for an individual person when they are first diagnosed. Unfortunately for the vast majority of people with myeloma there is no cure, and any treatment will be trying to slow down the development of the disease and control any symptoms.

Sometimes the disease can be slow growing or it may be diagnosed at an early stage before it is causing any problems. Both of these may affect how long a person may live with myeloma. However the prognosis can still be difficult to predict.

There are well-tested staging systems such as the one developed by Durie and Salmon, which can help the doctors to determine the stage of a person's myeloma. This can help to give some indication of prognosis. Durie and Salmon's staging system looks at the haemoglobin level, calcium, renal function, amount of bone disease and level of the myeloma protein in the blood or urine. This may identify people with very early stages of myeloma that do not require therapy. It can also identify those with more advanced stage disease that tend to have a worse prognosis.

However, this is not 100% accurate and has led to the investigation of other prognostic markers such as beta 2 microglobulin level, lactate dehydrogenase level, C-reactive protein level, myeloma cell appearances under the microscope, the presence and number of myeloma cells in the blood as well as specialised tests looking at the rate of growth of the myeloma cells.

The treatment you have, and how the disease responds, will also affect your the outcome. Information about a treatment is generally based on treating large groups of people. Your doctors will be able to tell you how 100 similar people responded to treatment X or what happened to 100 people with disease Y. However, people usually want to know what is likely to happen for them and this uncertainty can be very difficult to deal with.

For most conditions there have been studies looking at various factors that can predict who is going to do well and who is going to do poorly. This is important in counselling patients appropriately but is also important in guiding treatments. These systems allow doctors to give stronger treatment to people with a poor prognosis and to avoid strong treatments with potential side effects for people with a good prognosis.

Other important variables include the person's age and the treatment that they are able to receive, such as high-dose therapy or a bone marrow transplant.

It is important to emphasise that none of these pieces of information are absolute predictors of the future, and the information that they give must be put into context for each individual person. Your doctor will explain what your unique risk factors are and what this may mean for you in terms of treatment and prognosis.