Symptoms of Multiple Myeloma

Multiple myeloma (also referred to as myeloma) is a rare type of blood cancer characterized by improper function and excessive production of plasma cells—a type of white blood cell—found in bone marrow. Common symptoms of the disease may include bone pain (in the back or ribs), symptoms of infection (such as fever) and extreme weakness and fatigue. A new diagnosis of any type of cancer can be overwhelming, but learning about the signs, symptoms and complications can help people with myeloma know what to expect. 

Common Symptoms

The specific symptoms of multiple myeloma, including the age of onset and the rate of its progression, vary from person to person. Some people do not have symptoms at all in the early stage of the disease. This is referred to as being asymptomatic. The disease may start out as asymptomatic, then begin to suddenly cause serious complications, some that may even be life-threatening. Usually, people with myeloma do not have every symptom, but common symptoms may include:

  • Constipation
  • Nausea and vomiting
  • Loss of appetite
  • Weight loss
  • Excessive thirst
  • Mental fogginess
  • Confusion
  • Extreme weakness and fatigue
  • Frequent urination
  • Weakness and numbness in the legs
  • Frequent infections, fevers, and illness
  • Shortness of breath
  • Debilitating bone pain
  • Other bone problems (such as tumors and/or destruction of bone tissue)

As the disease progresses, serious health problems such as bone destruction, anemia, and kidney failure commonly occur. 

The most common symptom of multiple myeloma is bone pain, usually experienced in the lower back and ribs.

Underlying Causes of Common Symptoms

Fatigue: Caused by the body’s need to work harder to fight off
invading bacteria, viruses, or fungi, fatigue is the result of the impact of unhealthy myeloma cells replacing the healthy immune-fighting cells in the bone marrow.

Debilitating bone pain: Bone tumors can press up against a nerve from the accumulation of myeloma cells, or from osteolytic lesions—softened sections of the bone—which are painful and can result in painful bone fractures.

Bone destruction: Plasma cell tumors cause loss of bone density (osteopenia or osteoporosis) and weaken bones; the bones of the spine oftentimes become involved, causing the collapse of the vertebrae. This can lead to spinal cord compression, severe back pain, and numbing and weakness of arms and legs. Damage to bones can also result in a condition called hypercalcemia (increased blood calcium levels) which may cause symptoms of nausea, lack of appetite, abdominal and muscle pain, weakness, excessive thirst, and confusion.

Kidney problems: Kidney problems occur as a result of overproduction and excretion of uric acid in the urine, which can lead to kidney stones. Myeloma cells that produce harmful proteins (called M proteins) that are filtered by the kidneys can also cause kidney problems. These proteins can eventually damage the kidneys and lead to kidney failure. Bence Jones proteins caused by pieces of monoclonal antibodies (also known as light chains) in the urine or blood can end up in the kidneys, sometimes causing permanent kidney damage.

Low blood count: The crowding of healthy blood cells by myeloma cells can result in low white blood cell count (called leukopenia) which lowers the body’s ability to fight infection. The most common infection in people with myeloma is pneumonia. Other conditions resulting from crowding of healthy cells by myeloma cells include low red blood cell count (anemia, which can cause symptoms such as weakness, fatigue, dizziness, shortness of breath, and pale skin) or low platelet count (called thrombocytopenia). Thrombocytopenia interferes with the body’s ability to properly stop bleeding and may present as nosebleeds (epistaxis), bruising, or small broken blood vessels on the surface of the skin.

Symptoms by Stage

Staging of multiple myeloma is used to classify the level of impact myeloma has on the bones and kidneys as the disease progresses. This classification system is referred to as the Durie-Salmon system, which is based on the level of calcium in the blood and other lab test levels, such as hemoglobin (associated with red blood cell count) and monoclonal immunoglobin (the measurement of M proteins). A low level of hemoglobin combined with a high level of monoclonal immunoglobin indicates a higher severity of the disease.

Stages of multiple myeloma include:

Smoldering stage: Involves no active symptoms. Very few myeloma cells are present in the body (they may not even be detectable in lab tests) and are not causing any damage to the kidneys or bones.

Stage 1: Involves a low number of myeloma cells in the blood and urine. Hemoglobin levels are slightly below normal. Bone x-rays are normal or show only a single area that is affected.

Stage 2: Involves a moderate number of myeloma cells which are present in the blood and urine. Hemoglobin levels are much lower than the normal level while monoclonal immunoglobulin and blood calcium levels are increased. Several areas of bone damage are detected in imaging studies, like x-rays.

Stage 3: Involves a high number of myeloma cells which are present in the blood and urine. The hemoglobin levels are very low (usually below 8.5 grams/deciliter) and calcium blood levels are high. Multiple levels of bone damage are detected.

Relapse Symptoms

Oftentimes people with multiple myeloma will experience what is called a remission. This means that the treatment (chemotherapy or other treatment) has stopped the progression of the disease. During a remission from myeloma, lab tests no longer show any signs of the disease. If myeloma symptoms (including positive lab results) return, this is referred to as a relapse.

Although no symptoms are present during a remission, there are still a few abnormal myeloma cells that remain in the body, but too few for diagnostic tests to identify. These remaining myeloma cells can become active and begin to multiply—this is what many people with multiple myeloma experience as relapse. During a relapse, the same symptoms that originally occurred may come back, or a person may experience different symptoms. People in remission from multiple myeloma may be symptom-free for months or even years.

Symptoms of myeloma relapse may include:

  • Extreme fatigue and weakness
  • Bruising or bleeding (such as epistaxis)
  • Recurring infections

For people with myeloma, it’s important to consult with the health care provider if any of these symptoms (or any other unusual symptoms) occur.

Complications

Complications from multiple myeloma usually result from the buildup of abnormal proteins in the body, the impact on bone marrow (such as a decrease in normal blood count) and from bone tumors or destruction of normal bone tissue. Complications may include:

  • Back pain
  • Kidney problems
  • Recurrent infections
  • Bone complications (such as fractures)
  • Anemia
  • Bleeding disorders
  • Neurologic disorders (spinal cord and nerve compression, peripheral neuropathy, etc.)

Rare Symptoms

Rare complications that some people who have myeloma experience may include:

Hepatomegaly or splenomegaly: An enlarged liver or spleen. Symptoms may include:

  • Abdominal pain
  • Nausea and vomiting
  • Swelling of the abdomen
  • Fever
  • Persistent itching
  • Jaundice
  • Yellow urine

Hyperviscosity syndrome: An abnormally thick blood consistency caused by the buildup of M-proteins. Symptoms may include:

  • Headaches
  • Fatigue
  • Frequent bruising
  • Gastrointestinal bleeding
  • Visual abnormalities (such as retinopathy)

Cryoglobulinemia: Caused by a buildup of abnormal proteins called cryoglobulins in the blood. Upon exposure to cold, these proteins gel up or thicken, causing symptoms such as: 

In some instances, cryoglobulinemia does not cause any symptoms.

Amyloidosis: Caused by the buildup of an abnormal, sticky amyloid protein in body tissues which can cause affected organs to function improperly. Symptoms may include:

  • Swelling of the ankles and legs
  • Severe fatigue and weakness
  • Shortness of breath
  • Numbness, tingling, or pain in the hands or feet
  • Carpal tunnel syndrome
  • Constipation
  • Diarrhea
  • Weight loss
  • Enlarged tongue
  • Skin changes (thickening or easy bruising, and purplish discoloration around the eyes)
  • Irregular heartbeat
  • Difficulty swallowing

When to Seek Emergency Medical Care

A person with multiple myeloma should seek emergency medical care any time there is an unexpected change in symptoms, such as:

  • Any sudden change in physical or mental condition
  • Severe pain
  • Fever (or other signs of infection)
  • Severe nausea, vomiting or diarrhea (that is not improved by medication prescribed by the doctor)
  • Bleeding
  • Shortness of breath
  • Extreme weakness (affecting a part of the body)
  • Confusion
  • Excessive bruising
  • Swelling or numbness in the extremities
  • Injury or trauma
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