Symptoms

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There are often no symptoms in the early stages of myeloma. In some cases, myeloma may be discovered by accident during routine blood testing. When present, symptoms may be vague and similar to those of other conditions.

The chart below lists some of the more common symptoms of myeloma, describes the biological process involved, and presents the management options available for each. Please note that it is unusual for any one patient to have all of these symptoms.

Symptom	Description and cause	Management Options
Kidney problems	Excess protein in the blood, which is filtered through the kidneys, can cause kidney damage and lead to renal failure. Increased calcium in the blood (hypercalcemia) overworks the kidneys and can cause a variety of symptoms, including loss of appetite, fatigue, muscle weakness, restlessness, difficulty in thinking or confusion, constipation, increased thirst, increased urine production, and nausea and vomiting	Hydration; avoidance of non-steroidal anti-inflammatory drugs and intravenous contrast agents; for hypercalcemia: hydration and steroids plus furosemide and bisphosphonates
Pain	A common early symptom of multiple myeloma is pain in the lower back or in the ribs. This is the result of tiny fractures in the bones caused by accumulation of plasma cells and weakened bone structures	Proper positioning and support; increasing physical activity in consultation with physical/occupational therapists; bisphosphonates; radiation therapy; for spinal fractures: surgical procedures such as kyphoplasty or vertebroplasty
Fatigue	As the number of malignant plasma cells increases in the bone marrow, the growth and development of red blood cells in the bone marrow may be suppressed, leading to low levels of red blood cells in the blood (anemia). Anemia can result in unusual tiredness and abnormal paleness	Erythropoietin or darbepoetin therapy Transfusions (anemia)
Recurrent infection	Myeloma patients have as much as a 15-fold increase in risk of infections, particularly pneumonia. As the number of myeloma cells increases, the blood often produces fewer white cells to fight infection, leading to an overall reduction in immunity from infections (bacterial pneumonia, urinary tract infections, and shingles).	Appropriate antibiotic therapy; for recurrent, life-threatening infections: intravenous immunoglobulin therapy
Nervous system dysfunction	Weakening and collapsing bone structures may impinge on nerves, producing severe pain, tingling or numbness. Myeloma cells often produce abnormal proteins which contribute to the symptoms, and, in large amounts, cause a dangerous thickening of the blood known as hyperviscosity.	Treat as a medical emergency; contact your physician immediately for full investigation.

Much less frequent symptoms with multiple myeloma are related to complications that may occur with the disease. These complications include:

Hyperviscosity syndrome, which occurs when the protein concentration in the blood becomes very high and the blood becomes very thick and sticky. Signs and symptoms of hyperviscosity are shortness of breath, confusion, and chest pain.
Cryoglobulinemia, which may occur when the paraprotein is of a specific type that comes out of solution as particles when exposed to cold temperatures. These particles may block small blood vessels and cause symptoms such as pain and numbness in the fingers and toes in cold weather.
Amyloidosis, which is a rare complication that occurs more often in patients whose plasma cells produce only light chains. Light chains can combine with other serum proteins to produce amyloid protein, a starch-like substance. The amyloid protein may be deposited in various tissues and organs, including the nerves, kidneys, liver, and heart, and disrupt their normal functions. Also, amyloid protein can stick to the walls of blood vessels, causing them to lose their elasticity and make it difficult to maintain blood pressure. Amyloidosis may produce neuropathies (numbness, tingling and/or pain especially in the hands and feet), low blood pressure and kidney, heart, or liver failure. Amyloidosis is a disease that also occurs in individuals who do not have multiple myeloma.

Reviewed by:
Sagar Lonial Photo

Sagar Lonial, MD
Asst. Professor, Director of Transslational Research, B-cell Malignancy Program
Emory University School of Medicine

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