Signs and Symptoms of Multiple Myeloma

Multiple myeloma is a rare blood cancer that affects your plasma cells. It makes up about 1.8% of all new cancer cases each year and about 10% of all blood cancers. You may not experience symptoms of multiple myeloma in the precancerous and early stages. If your cancer advances, the most common symptoms are anemia, bone pain, kidney problems, and hypercalcemia (elevated calcium levels in your blood).

Plasma cells are white blood cells that make antibodies to fight infections. In multiple myeloma, your plasma cells are transformed into cancerous cells that multiply out of control. These cancerous cells, also called myeloma cells, alter your blood composition and bone structure.

Over time, the myeloma cells take over your normal plasma cells and crowd out the other cell types in your blood. The cancer cells also collect in your bones and bone marrow, where your normal blood cells are made. This interferes with the production of normal red blood cells, white blood cells, and platelets.

Anemia

Your red blood cells carry oxygen to every part of your body. When the number of red blood cells in your blood is reduced to a low enough level, you have anemia. When you have multiple myeloma, your body is not making enough red blood cells because the increased number of myeloma cells is pushing out your red blood cells. This means your body is not getting enough oxygen.

Anemia can cause symptoms such as:

• Shortness of breath
• Weakness
• Fatigue
• Exhaustion during physical activity
• Dizziness

About 60% of people with multiple myeloma experience anemia when they are diagnosed, and all people with multiple myeloma will experience anemia at some point. If your anemia is severe, you may need a blood transfusion, which is when donated blood is put into your veins.

Bone Pain

Myeloma clusters eventually travel to your bones and enter your bone marrow, the inside part of all your bones. The clusters interfere with the normal structure of your bone marrow and the surrounding bone, leading to bone weakness and damage.

Multiple myeloma also weakens your bones by increasing the activity of cells that break down your bones (called osteoclasts), which cause tiny holes in your bones.

Pain is a result of weakness in your bones that occurs due to this process. Your bone pain can occur all over or in specific areas of your body, most often your hips, back, and ribs. When your bones are weak, you are more likely to break bones, even from a minor injury or stress.

Kidney Problems

Your myeloma cells can also build up in your kidneys. When this happens, it disrupts the normal filtering function of your kidneys. Your kidneys are responsible for filtering water, salt, and waste products like urine out of your body. If your kidneys cannot do their job, it will lead to kidney failure. Some signs of kidney failure are:

• Weakness
• Shortness of breath
• Itching
• Leg swelling

Early on, kidney function disruption does not cause symptoms. By the time you experience symptoms, your kidneys are failing. More than half of people with multiple myeloma will have disruption of their kidney function.

Hypercalcemia

A high calcium level in the blood, also called hypercalcemia, can occur when myeloma cells damage your bones and the calcium from your bones gets into your bloodstream. If your blood calcium level gets too high, it can lead to serious complications, including:

• Excessive thirst
• Increased urination
• Kidney problems, including kidney failure
• Severe constipation
• Abdominal pain
• Loss of appetite
• Nausea and vomiting
• Weakness
• Drowsiness
• Confusion
• Restlessness

If your calcium level gets severely high, it can lead to a coma.

Thrombocytopenia

Platelets are another type of blood cell that gets crowded out by your myeloma cells. Platelets are responsible for blood clotting, which is a natural process that occurs to stop excessive bleeding. When your platelet level drops, it is called thrombocytopenia. Decreased platelet levels can lead to:

• Impaired blood clotting
• Heavy bleeding from minor cuts or scrapes
• Bruising easily from normal activity or minor injury

In severe cases, you may need a platelet transfusion.

Leukopenia

White blood cells also get crowded out by myeloma cells. These cells produce antibodies, which are responsible for fighting off infections. Having too few white blood cells—a state known as leukopenia—means your immune system is weakened because you are not able to produce enough antibodies.

With a weakened immune system, you are prone to frequent infections. If you have multiple myeloma, you are 15 times more likely to get an infection than someone who does not have myeloma. Some signs of a weakened immune system include:

• Frequent fevers
• Frequent infections
• Slow response to medical treatments
• Staying sick for long periods

When to Contact a Healthcare Provider

Some symptoms require immediate attention. If you are experiencing any kidney problems or hypercalcemia, see your healthcare provider immediately.

Contact your healthcare provider if you think you may have a weakened immune system and have symptoms of an infection:

• Chills
• Coughing
• Diarrhea
  
• Fever over 100.5 degrees
• Increased fatigue
• Muscle aches
• Pain or redness at the site of a cut
• Sore throat
  
• Unusual sweating patterns
  

A Quick Review

Multiple myeloma is a rare blood cancer of your plasma cells. The cancer cells multiply too much and take over the other blood cell types. The most common symptoms are anemia, bone pain, kidney problems, and high levels of calcium in your blood. You can be asymptomatic during the early stages of the cancer. See your healthcare provider right away if you experience any of the symptoms.