Symptoms

For additional information, please visit the National Cancer Institute.

Skeletal Symptoms
Seventy-five percent of patients present with bone pain, frequently in the back, long bones, pelvis and skull. Lower back pain is a common complaint.

Malignant plasma cells release osteoclast stimulating factors (including IL-1, IL-6 and TNF) which cause calcium to be leached from bones. This can result in lytic lesions, or holes that look as though they were punched out, causing severe pain and bone weakness. The risk of fractures increases, with compression fractures of the thoracic and lumbar vertebral bodies being quite common. Multiple compression fractures may culminate in kyphosis, a forward curving of the spine, with resultant loss of height. The osteoclast stimulating factors, also referred to as cytokines, may prevent apoptosis, or death of myeloma cells.

Fifty percent of patients have radiologically detectable myeloma-related skeletal lesions at diagnosis. The MTRC has found Magnetic Resonance Imaging (MRI) to be more effective than conventional x-rays at demonstrating the existence and exact location of bone tumors and lesions. MRI is a standard diagnostic tool for patients being evaluated at the MTRC.

Hypercalcemia
Hypercalcemia refers to elevated levels of calcium in the blood. This results when bone is resorbed (calcium being leached from the bones). Excess calcium in the blood can affect nerve function; it can cause nausea, weakness and confusion. Raised calcium levels place an excessive burden on the kidneys and, if untreated, may cause impaired kidney function. Hypercalcemia occurs in 15% of patients with multiple myeleloma at diagnosis. It is often accompanied by anorexia.

Polyneuropathy
This is observed in 5-15% of myeloma patients. It is characterized by tingling sensations and/or numbness in the hands and feet, and muscle weakness in the legs and arms.

Anemia
Anemia commonly occurs in almost all multiple myeloma patients. Anermia can cause weakness, dizziness, shortness of breath, fatigue.

Anemia can result from:

• Heavy infiltration in the bone marrow of malignant cells, which crowd out healthy cells, including red cells. (Red cells carry oxygen throughout the body.)
• Renal impairment leading to deficient production of erythropoietin, a hormone produced by the kidneys that stimulates red blood cell production.

Hyperviscosity
Hyperviscosity refers to an increase in the viscosity, or resistance to flow, of the blood. It is due to high levels of protein in the blood, specifically M proteins that attach themselves to platelets and interfere with platelet function. Hyperviscosity can result in:

• Bruising
• Nose bleeding
• Hazy vision
• Headache
• Gastrointestinal bleeding
• Sleepiness
• Neurological symptoms (such as tingling or numbness in extremities)

Infections
Multiple myeloma patients are at significant risk for contracting infections, because their white blood cell counts are reduced (white blood cells produce the antibodies that fight infection). White blood cell counts are reduced because plasma cells crowd out the white cells. If a patient has received chemotherapy, white blood cell counts may be further reduced, thus increasing even more the risk for infection.

Renal Insufficiency
20+% of multiple myeloma patients have impairment of kidney function at diagnosis. This is typically caused by the excess protein in the blood, which coats the platelets, which then overburden the kidneys' filtering system. When the kidneys are not functioning at normal capacity, they are not as effective at disposing of excess salt, fluid and body waste products.

It is extremely important for myeloma patients to consume large quantities of water to maintain hydration and thereby reduce the risk of dehydration which can contribute to renal failure.

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