Multiple myeloma can affect the body in a multitude of ways.
Multiple myeloma is a cancer of the plasma cell, which is a type of white blood cell. These cells live in the bone marrow and are key for healthy immune system function. Normally, those white blood cells make antibodies to help fight off infection.
“In myeloma, [the plasma cells] misbehave and start making an antibody that’s completely useless,” says Adriana Rossi, MD, associate clinical director of the Myeloma Center at Weill Cornell Medicine and NewYork-Presbyterian.
This abnormal antibody, called M protein, floats around and can be toxic to kidneys or attack other parts of the body, she says.
“So instead of helping you fight an infection, the [abnormal plasma cells] just sort of accumulate,” says Dr. Rossi. These “misbehaving” cells then crowd out the normal, infection-fighting plasma cells, which can lead to low blood counts and low immune cells. The change in blood cells can affect the body in different ways.
“Lesions in the bones tend to lead to bone pain,” said Dr. Rossi. “About 80 percent of patients will come up with some sort of bone pain.”
Patients may feel bone pain in the back or chest, or less commonly, the arms and legs, at the time of diagnosis. Patients may also experience bone loss throughout the body which can lead to osteoporosis and fractures. (Learn more about what happens to your body during osteoporosis.)
Anemia is a condition in which you don’t have enough healthy red blood cells to carry oxygen to your body’s tissues. It can cause paleness, weakness, and fatigue.
Impaired kidney function
The excess proteins and high blood calcium levels that may come with multiple myeloma can damage the kidneys and lead to kidney failure.
Decreased kidney function doesn’t often show symptoms until it’s escalated to kidney failure, says Dr. Rossi. “Spilling proteins can cause foam in the urine, so that’s something that [they may] notice.”
“The good news is that most of the time, if the kidney failure is due to myeloma, we can reverse it entirely,” says Dr. Rossi.
Multiple myeloma can affect the nerves in different ways. “The antibodies that are floating around can directly attack nerves,” says Dr Rossi. Symptoms may include odd sensations (numbness or tingling), pain, or muscle weakness.
Multiple myeloma in the spine, however, can have more severe complications. “[It can] push up against the spinal cord and cause constant back pain and pain that radiates down the legs or causes weakness in the legs. That is a medical emergency that requires immediate attention,” says Dr. Rossi.
Multiple myeloma patients don’t have a fully functional immune system, so they’re much more likely to get infections, says Dr. Rossi. Pneumonia is a common and serious infection seen in myeloma patients.
“There are ways to support the patient’s immune system,” says Dr. Rossi. “If they are not able to make their own antibodies, [we can provide] antibodies from other healthy individuals to keep infections at bay.”
How to Manage Multiple Myeloma Symptoms
“The best way to alleviate symptoms due to multiple myeloma is to treat the disease itself,” says Dr. Rossi. “Anti-myeloma therapy tends to be very effective in recovering kidney function, building up your blood counts, and decreasing your bone pain.”
“It’s important for everyone to have a good relationship with their primary care doctor and bring up any concerns that they have,” says Dr. Rossi.
Adriana Rossi, MD, is the Associate Clinical Director of the Myeloma Center at Weill Cornell Medicine and NewYork-Presbyterian.
00:00:01,270 --> 00:00:05,200
Patients with myeloma don't have
a fully functioning immune system.
00:00:05,200 --> 00:00:07,800
So it's important that patients
always tell us things.
00:00:07,800 --> 00:00:11,510
An absurd thing is a patient saying,
I don't want to bother you.
00:00:11,510 --> 00:00:13,620
So if we don't know you're
having a symptom or
00:00:13,620 --> 00:00:16,970
you're having a hard time with the
medication, we can't do anything about it.
00:00:16,970 --> 00:00:22,279
00:00:22,279 --> 00:00:25,760
Most patients are not aware
of decreased kidney function.
00:00:25,760 --> 00:00:29,470
So unless there is a lot
of kidney involvement,
00:00:29,470 --> 00:00:31,790
there's no symptoms associated with it.
00:00:31,790 --> 00:00:35,840
The good news is that most of the time,
if the kidney failure is due to myeloma,
00:00:35,840 --> 00:00:39,560
we can reverse it entirely and
get the patient off dialysis
00:00:39,560 --> 00:00:43,170
as long as we're diagnosed in time and
start treatment right away.
00:00:43,170 --> 00:00:46,830
Another thing that patients
will present with is bone pain.
00:00:46,830 --> 00:00:51,790
The bony pain from myeloma tends to
be insidious, which means constant.
00:00:51,790 --> 00:00:54,450
Nothing really makes it better or
makes it go away.
00:00:54,450 --> 00:01:00,540
Some things can make it worse like
heavy lifting, or movement of any kind.
00:01:00,540 --> 00:01:05,960
It tends to be mostly in the spine, ribs,
pelvis, but it could affect any bone.
00:01:05,960 --> 00:01:10,250
And since myeloma sort of thins the bone,
they're at increased risk of fracture.
00:01:10,250 --> 00:01:13,500
So many times there's a very sharp start.
00:01:13,500 --> 00:01:16,407
You know a patient will come in and
say, I picked up the groceries and
00:01:16,407 --> 00:01:17,880
that's when it started.
00:01:17,880 --> 00:01:19,510
And it hasn't gone away.
00:01:19,510 --> 00:01:21,480
It also usually it doesn't affect joints.
00:01:21,480 --> 00:01:25,000
So pains in the joints
tend to not be myeloma.
00:01:25,000 --> 00:01:27,890
It can also cause peripheral neuropathy,
which is numbness or
00:01:27,890 --> 00:01:29,990
tingling in the hands or feet.
00:01:29,990 --> 00:01:35,350
But myeloma in the spine can also push up
against the spinal cord and cause constant
00:01:35,350 --> 00:01:40,590
back pain and pain that radiates down
the legs or causes weakness in the legs.
00:01:40,590 --> 00:01:44,650
That is a medical emergency that
requires immediate attention.
00:01:44,650 --> 00:01:47,280
Certain therapies can cause
00:01:47,280 --> 00:01:51,900
And so we're very attentive to
decreasing the dose and putting
00:01:51,900 --> 00:01:56,160
them on appropriate other therapies,
sometimes with the help of a neurologist.
00:01:56,160 --> 00:02:00,840
Nausea, diarrhea, GI toxicity is
something that is also fairly common, and
00:02:00,840 --> 00:02:03,270
we're quite good at mitigating,
00:02:03,270 --> 00:02:07,180
using something to prevent the symptoms
rather than treating them after the fact.
00:02:07,180 --> 00:02:12,188
Plasma Cell Neoplasms (Including Multiple Myeloma)—Patient Version. The National Cancer Institute. (Accessed on June 26, 2019 at https://www.cancer.gov/types/myeloma)
Multiple Myeloma Symptoms, Diagnosis, and Staging. UpToDate. (Accessed on June 26, 2019 at https://www.uptodate.com/contents/multiple-myeloma-symptoms-diagnosis-and-staging-beyond-the-basics)