Signs and Symptoms of Multiple Myeloma

Some people with multiple myeloma have no symptoms at all. But sometimes multiple myeloma does cause symptoms.

Bone problems

• Bone pain, which can be in any bone, but is most often in the back, the hips, or skull
• Bone weakness, either all over (osteoporosis), or where there is a tumor
• 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: Having too few red blood cells can cause weakness, a reduced ability to exercise, shortness of breath, and dizziness.
• Leukopenia: Having too few white blood cells can lower resistance to infections such as pneumonia.
• Thrombocytopenia: Having too few blood platelets 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 of fluids
• Urinating (peeing) a lot
• Dehydration
• Kidney problems, or even kidney failure
• Severe constipation
• Abdominal (belly) pain
• Loss of appetite
• Weakness
• Feeling drowsy
• Confusion

If the level of calcium gets high enough, a person 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 it can cause:

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

This is a medical emergency, so you should contact your doctor right away or go to the emergency room if you have any of these symptoms. 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 can damage nerves. This can lead to weakness and numbness and sometimes a “pins and needles” sensation. This is called peripheral neuropathy. 

Hyperviscosity

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

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

People with these symptoms need to 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 most likely won't cause any symptoms, but signs of kidney damage may be seen on a blood test or a urine test. If 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

People with myeloma 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 people with myeloma.

Signs and symptoms of light chain amyloidosis

People with amyloidosis (discussed in What Is Multiple Myeloma?) can have some of the same health issues as people 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: A person may feel the liver below the right ribs. When this gets large it can press on the stomach, so the person might feel 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: Symptoms can include changes in the color or texture of the skin, easy bruising, and bleeding into the skin around the eyes (“raccoon eyes”)
• Carpal tunnel syndrome: This can cause numbness and weakness in the hands.