Signs and Symptoms of Multiple Myeloma

Some patients with multiple myeloma have no symptoms at all. Others can have common symptoms of the disease including:

Bone problems

• Bone pain, which can be in any bone, but is most often in the back, the hips, and skull
• Bone weakness, either all over (osteoporosis), or where there is a plasmacytoma
• Broken bones (fractures), sometimes from only a minor stress or injury

Low blood counts

Shortages of red blood cells, white blood cells, and blood platelets are common in multiple myeloma and might lead to other symptoms.

• Anemia: A reduced number of red blood cells that can cause weakness, a reduced ability to exercise, shortness of breath, and dizziness.
• Leukopenia: Too few white blood cells that can lower resistance to infections such as pneumonia.
• Thrombocytopenia: When blood platelet counts are low which may cause serious bleeding even with minor scrapes, cuts, or bruises. .

High blood levels of calcium

High levels of calcium in the blood (called hypercalcemia) can cause:

• Extreme thirst, leading to drinking a lot
• Urinating (peeing) a lot
• Dehydration
• Kidney problems and even kidney failure
• Severe constipation,
• Abdominal (belly) pain
• Loss of appetite
• Weakness
• Feeling drowsy
• Confusion

If the level of calcium gets high enough, you can even slip into a coma.

Nervous system symptoms

If myeloma weakens the bones in the spine, they can collapse and press on spinal nerves. This is called spinal cord compression and can cause

• Sudden severe back pain
• Numbness, most often in the legs
• Muscle weakness, most often in the legs.

This is a medical emergency and you should contact your doctor right away or go to the emergency room. If spinal cord compression is not treated right away, there is a possibility of permanent paralysis. 

Nerve damage

Sometimes, the abnormal proteins produced by myeloma cells are toxic to nerves. This damage can lead to weakness and numbness and sometimes a “pins and needles” sensation. This is also called peripheral neuropathy. 

Hyperviscosity

In some patients, large amounts of myeloma protein can cause the blood to “thicken.” This thickening is called hyperviscosity. It can slow blood flow to the brain and cause:

• Confusion
• Dizziness
• Symptoms of a stroke, like weakness on one side of the body and slurred speech

Patients with these symptoms should call their doctor. Removing the protein from the blood using a procedure called plasmapheresis can rapidly reverse this problem. (Note: This is not something that can be treated with drugs known as “blood thinners.”)

Kidney problems

Myeloma protein can damage the kidneys. Early on, this doesn’t cause any symptoms, but signs of kidney damage may be seen on a blood test or a urine test. As the kidneys start to fail, they lose the ability to get rid of excess salt, fluid, and body waste products. This can lead to symptoms such as:

• Weakness
• Shortness of breath
• Itching
• Leg swelling.

Infections

Myeloma patients are much more likely to get infections. When someone with myeloma gets an infection, they may be slow to respond to treatment. That person may stay sick for a long time. Pneumonia is a common and serious infection seen in myeloma patients.

Signs and symptoms of light chain amyloidosis

Patients with amyloidosis (discussed in What Is Multiple Myeloma?) can have some of the same problems as patients with myeloma, such as kidney problems and nerve damage. They can also have other problems, such as:

• Heart problems: The heart may enlarge and become weaker. In some people, the heart becomes so weak that fluid builds up in the lungs, making them feel short of breath. Fluid may also build up in the legs and feet (edema). This is called congestive heart failure.
• Enlarged liver: The person may feel the liver below the right ribs. When this gets large it can press on the stomach so the person feels full after eating only a small amount of food.
• Enlarged tongue: When amyloid builds up in the tongue it can get larger. This can lead to problems swallowing and problems breathing during sleep (sleep apnea).
• Skin changes: Changes in the color or texture, easy bruising, and bleeding into the skin around the eyes (“raccoon eyes”)
• Kidney problems
• Carpal tunnel syndrome: Which causes numbness and weakness in the hands.