Symptoms of Multiple Myeloma

Common symptoms of multiple myeloma may include bone pain (in the back or ribs), fever, extreme weakness, and fatigue. A 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. 

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 of which may even be life-threatening. Usually, people with myeloma do not have every possible symptom. However, 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. 

Underlying Causes of Common Symptoms

Fatigue: Fatigue in myeloma is usually caused by the anemia that is typical of this disease.

Debilitating bone pain: Bone tumors can press up against a nerve from the accumulation of myeloma cells, or from osteolytic lesions, which are painful and can result in 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 may occur as a result of overproduction and excretion of uric acid in the urine, which can lead to kidney stones. However, excessive uric acid production is usually a minor contributor to the kidney insufficiency often seen in myeloma. 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 (also known as light chain proteins), caused by pieces of monoclonal antibodies in the urine or blood, may also end up in the kidneys. These proteins are the major contributor to kidney disease in myeloma and sometimes cause 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.

Relapse Symptoms

Oftentimes people with multiple myeloma will experience what's 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—which 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 can 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

It’s important for people with myeloma to consult with their healthcare 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 disease's impact on bone marrow (such as a decrease in normal blood count), and bone tumors or the 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 the following.

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: 

• Joint pain
• Raynaud’s syndrome
• Weakness
• Purpura

In some cases, 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