Myeloma Symptoms

Multiple myeloma is a relatively rare type of blood cancer that develops when plasma cells form tumors in the bone marrow. These cancerous cells then produce an abnormal protein called M protein, leading to damage of the bones, immune system and kidneys, while also depleting levels of normal blood cell counts.

The American Cancer Society estimates that 35,780 new cases of multiple myeloma will be diagnosed in the United States in 2024.

Not every person who is diagnosed with multiple myeloma has symptoms. Often, the cancer is detected during routine blood work. Symptoms often begin when multiple myeloma reaches an advanced stage.

Symptoms of Myeloma

When multiple myeloma advances, symptoms may occur. Symptoms may include those listed below. Every patient with multiple myeloma is unique in their presentation and response to treatment.

Keep in mind that the myeloma treatment plan the care team recommends is based on a variety of factors, including the myeloma type, the patient’s overall health and other factors. Some possible treatment options are highlighted below for symptom management, but most symptoms won’t subside completely until the actual disease is treated.

Bone Problems

Issues with the bones may include bone pain, brittle bones or fractures, most commonly in the back or ribs. When myeloma cells grow in bone and marrow, they may cause brittleness, setting the stage for osteoporosis and related fractures. As many as 85% of people with multiple myeloma develop bone damage, according to the Multiple Myeloma Research Foundation.

Treatment: Regular exercise, calcium and vitamin D supplements, and medications that help treat osteoporosis — as well as other pain management techniques, orthopedic procedures and low-dose radiation therapy — are often used.

Decreased Red Blood Cells, or White Blood Cells

Some people with multiple myeloma develop anemia if their red blood cells dip too low. Anemia is marked by weakness, diminished capacity to exercise, shortness of breath and dizziness.

Treatment: Taking supplements of iron, folate or vitamin B12, along with medication to boost red blood cell growth factors, may be recommended. Blood transfusions may be required if anemia is severe.

A Shortage of White Blood Cells (Leukopenia)

Leukopenia may increase the risk of infections such as pneumonia. People with multiple myeloma are about 15 times more likely than individuals without this condition to get an infection, according to the Multiple Myeloma Research Foundation.

Treatment: To help prevent infection, patients may be asked to wash hands regularly, cook food thoroughly, avoid people who are ill and stay up to date on recommended vaccines. Sometimes, medications to boost a patient's white blood cell count may be administered during treatment.

Reduced Blood Platelets

Known as thrombocytopenia, reduced blood platelets may lead to bruising or bleeding, even with minor cuts.

Treatment: Treatment often involves limiting alcohol consumption and avoiding over-the-counter medications such as aspirin and ibuprofen, which may increase bleeding risk. Severe thrombocytopenia may require a platelet transfusion.

High Blood Calcium Levels

As a result of bone destruction, calcium levels in the blood may rise to dangerous levels, a condition called hypercalcemia. It may cause extreme thirst, as well as the need to drink a lot and urinate frequently.

Other signs of high blood calcium levels may include:

• Dehydration
• Kidney disease
• Stomach pain and constipation
• Appetite loss
• Weakness
• Drowsiness
• Confusion

If a blood calcium level rises too high, a person may fall into a coma.

Treatment: Treatment starts with intravenous (IV) fluid, along with medications to stop bone from breaking down. Taking a hormone called calcitonin slows calcium release from the bones and increases secretion of calcium from the kidneys.

Spinal Cord Compression

Multiple myeloma may weaken the spine. Spinal cord compression occurs when these bones collapse and put pressure on the spinal nerves.

Symptoms of spinal cord compression may include:

• Severe back pain
• Numbness
• Muscle weakness in the legs

Treatment: Spinal cord compression must be treated right away, often with surgery and/or radiation therapy, to avoid permanent paralysis.

Nerve Damage

Abnormal proteins produced by myeloma cells may be toxic to nerves, causing weakness, numbness and a pins-and-needles-like sensation known as peripheral neuropathy.

Treatment: Certain vitamins may help relieve peripheral neuropathy. If symptoms are severe, nerve pain medication, physical therapy or adjustments in multiple myeloma treatment may help.

Hyperviscosity

Sometimes, large amounts of myeloma protein may cause the blood to thicken, a condition called hyperviscosity, which may slow blood flow to the brain.

Symptoms may include:

• Confusion
• Dizziness
• Stroke-like symptoms, such as weakness on one side of the body and slurred speech

Treatment: A procedure called plasmapheresis may remove the toxic protein from the blood and rapidly reverse symptoms of hyper viscosity.

Kidney Problems

Myeloma protein may damage the kidneys. In the initial stages of kidney disease, there may not be symptoms, but irregularities in a blood or urine test may point to impaired kidney function.

As kidney disease progresses, symptoms may include:

• Weakness
• Shortness of breath
• Itching
• Leg swelling