Multiple Myeloma Symptoms

Multiple myeloma is a type of blood cancer that affects plasma cells. It causes plasma cells to grow and multiply too fast in the bone marrow. Damaged plasma cells produce M protein, which cannot be used by the body. These problems usually cause the first signs and symptoms of multiple myeloma. “Signs” are measured by tests, like a blood test. “Symptoms” are something you feel in your body, like nausea or pain. 

Sometimes, myeloma does not cause any symptoms. It may be found through routine blood or urine tests as part of another medical appointment.

It is important to remember that many of the signs and symptoms listed below could be caused by something other than cancer. If you are concerned about health changes or a symptom you are experiencing, talk to a doctor.

What are the signs and symptoms of multiple myeloma?

Common signs and symptoms of multiple myeloma include: 

• Not enough red blood cells, white blood cells, or platelets

• Too much calcium in the blood

• Thickened blood

• Bone pain and bone fractures

• Kidney problems

• Nerve problems

• Unexplained weight loss

• Fatigue

Below, find detailed information about each symptom of multiple myeloma.

Low blood counts and other blood problems caused by multiple myeloma

Because multiple myeloma affects how well your body makes blood cells, it can cause low blood counts. 

Anemia is when there are too few red blood cells. As many as 7 in 10 people diagnosed with multiple myeloma are anemic when they are first diagnosed. Anemia causes fatigue, weakness, shortness of breath, a fast heartbeat, and infections.

Leukopenia is when there are too few white blood cells. Leukopenia does not cause any symptoms, but you may have more frequent infections.

Thrombocytopenia is when there are too few platelets. Thrombocytopenia causes bruising, dots on the skin called petechiae, bleeding, blood in urine or stools, and heavy periods.

Hypercalcemia is when there is too much calcium in the blood. Myeloma causes bone to break down faster, releasing extra calcium into the blood. Hypercalcemia can cause frequent urination, thirst, dehydration, stomach and digestion problems, appetite loss, fatigue, and confusion. Severe hypercalcemia can also affect the heart.

Hyperviscosity is when the blood gets thicker because of M proteins. This makes it difficult for blood to reach the brain. This can cause cloudy vision, confusion, weakness, and symptoms similar to a stroke. Any signs of a stroke or new and worsening confusion are an emergency. Seek medical attention right away.

Bone pain and fractures caused by multiple myeloma

Bone pain is one of the most common symptoms of multiple myeloma. This is because plasma cells are found in the bone marrow. As myeloma cells grow, they cause damage to bones. Bones become thinner and weaker (osteoporosis). Myeloma cells can also create lytic lesions, which are holes in the bone. Bone pain caused by multiple myeloma is most common in the back or ribs. But it can be felt anywhere in the body. 

Bones that fracture easily may also be a symptom of multiple myeloma. The damage and thinning caused by myeloma cells makes it easier for bones to fracture. Sometimes, even a small injury can cause a fracture. 

When multiple myeloma is in the spine, it can cause a compression fracture. A spinal compression fracture is a medical emergency. It is important to go to the emergency room if you have these symptoms: 

• Severe back pain

• Numbness, especially in the legs

• Weakness

Frequent fever and infections caused by multiple myeloma

People with multiple myeloma have a harder time fighting off infections because of damage to their immune system. This means people with myeloma get more frequent infections and they take longer to recover. 

Kidney problems caused by multiple myeloma

Often, one of the first signs of multiple myeloma is an abnormal result on a blood test or urine test showing signs of kidney damage. This is because M protein produced by myeloma cells collects in the kidneys. Hypercalcemia can also cause kidney damage. 

Usually, early kidney damage does not cause any symptoms. Over time, multiple myeloma can lead to kidney disease or kidney failure. Kidney damage is also called renal damage.

Symptoms of kidney disease include: 

• Confusion

• Muscle cramps

• Fatigue

• Itching

• Nausea

• Swelling of the legs, feet, and ankles

• Sleep problems

• Shortness of breath

More than half of people diagnosed with multiple myeloma will have elevated creatinine, a sign of kidney problems, at the time of their diagnosis.

Nerve problems

M proteins produced by myeloma cells cause damage to nerves called peripheral neuropathy or neuropathy. Signs of neuropathy include: 

• Numbness

• Weakness

• Pins and needles

What are the SLiM CRAB criteria for multiple myeloma?

The International Myeloma Foundation International Myeloma Working Group (IMWG) developed the CRAB criteria in 2003, which was updated to the SLiM CRAB criteria in 2014. These criteria indicate active myeloma and organ damage.

CRAB stands for:

• Calcium: Higher levels of calcium in the blood (more than 11mg/dL).

• Renal (kidney) impairment: High levels of creatinine in the blood (more than 2 mg/DL) or creatinine clearance of less than 40 mL per minute.

• Anemia - Hemoglobin value of less than 10g/dL.

• Bone damage - At least one osteolytic lesion. If bone marrow has less than 10% clonal plasma cells, more than one bone lesion is needed to confirm it isn't a plasmacytoma.

SLiM stands for:

• Sixty percent (60%) monoclonal plasma cells in the bone marrow.

• Light chains ratio of involved-to-uninvolved serum free light chain of 100 or more.

• MRI imaging of 2 or more focal lesions in the bone marrow.

People with one or more of the CRAB symptoms of myeloma are considered to have active myeloma. People with smoldering myeloma do not have CRAB symptoms. Learn more about smoldering myeloma.

Sources:

• International Myeloma Foundation. Multiple Myeloma Diagnostic Criteria. https://www.myeloma.org/newly-diagnosed/multiple-myeloma-diagnostic-criteria

• UpToDate. Multiple Myeloma Clinical Features. https://www.uptodate.com/contents/multiple-myeloma-clinical-features-laboratory-manifestations-and-diagnosis?search=multiple%20myeloma&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2