Key takeaways
- Multiple myeloma is a rare cancer that starts in the bone marrow with an atypical plasma cell, which leads to the overproduction of cancerous myeloma cells and M proteins. It can cause kidney damage and other health issues.
- The acronym “CRAB” helps explain some symptoms of multiple myeloma: elevated calcium levels, renal (kidney) failure, anemia (low red blood cell count), and bone damage. Early symptoms may include bone pain, fatigue, and nausea.
- While there is no cure for multiple myeloma, treatments such as targeted therapy, chemotherapy, and stem cell transplants can help manage pain, reduce complications, and slow the progression of the disease.
Multiple myeloma is a type of cancer that occurs when an atypical plasma cell develops in the bone marrow and reproduces quickly. The rapid reproduction of cancerous myeloma cells eventually overtakes the production of healthy cells in the bone marrow.
The cancerous myeloma cells produce atypical antibodies called monoclonal (M) proteins, which can cause kidney damage and other serious health issues.
Multiple myeloma is rare. The National Cancer Institute estimates that
In this article, we take a look at the symptoms, causes, and treatment of multiple myeloma.
Types of multiple myeloma
There are two main types of multiple myeloma:
- Indolent (smoldering) myeloma: This type does not cause bone tumors or any symptoms — it causes only small increases in M protein levels and myeloma cells.
- Active myeloma: In the active stage, myeloma cells and M proteins begin to build up, leading to signs and symptoms such as kidney damage, bone pain, and anemia.
The symptoms of multiple myeloma vary from person to person. It may not cause any symptoms at first. But as the disease progresses, most people will experience at least one of four major types of symptoms.
These symptoms are generally referred to by the acronym “CRAB”:
- C: calcium (elevated calcium levels)
- R: renal (kidney) failure
- A: anemia (low red blood cell count)
- B: bone damage
What are the first signs of multiple myeloma?
Early
- bone pain (particularly in your back or chest)
- fatigue
- nausea
High calcium level symptoms
High calcium levels in your blood can occur if the affected bones leak calcium. Too much calcium in your blood can cause:
Confusion and constipation are also common symptoms of increased calcium levels.
Kidney failure symptoms
High levels of M protein in your body can cause kidney damage or kidney failure. Possible symptoms of kidney damage or failure include:
- a decrease in urine production
- swelling of your legs, ankles, and feet
- unexplained shortness of breath
- excessive drowsiness or fatigue
- persistent nausea
- confusion
- pain or pressure in your chest
- seizures
- coma
Anemia symptoms
Anemia can happen when cancerous cells outnumber red blood cells in your bone marrow. Symptoms of anemia include:
- fatigue
- dizziness
- irritability
Bone damage symptoms
Bone injuries and fractures can happen if cancerous cells invade your bone and bone marrow. The lesions caused by the cancer cells can lead to bone pain, especially in your:
- back
- pelvis
- ribs
- skull
Additional symptoms of multiple myeloma
Other possible symptoms of multiple myeloma include:
- weakness or numbness, especially in your legs
- unintentional weight loss
- confusion
- difficulties with urination
- nausea
- vomiting
- repeated infections
- vision loss or vision problems
The exact cause of multiple myeloma is unknown. However, it starts with one atypical plasma cell that rapidly multiplies in your bone marrow.
The resulting cancerous myeloma cells do not have a typical life cycle. Instead of multiplying and eventually dying, they continue multiplying indefinitely. This can overwhelm your body and impair the production of healthy cells.
Risk factors for multiple myeloma
You may have a
- are male
- are over 50 years old
- are African American
- are overweight or have obesity
- have been exposed to radiation
- work in the petroleum industry
Another risk factor for multiple myeloma is a history of monoclonal gammopathy of undetermined significance (MGUS), a condition that causes plasma cells to produce M proteins. MGUS usually does not cause any problems, but it can sometimes develop into multiple myeloma over time.
Doctors often detect multiple myeloma before any symptoms are present. Routine physical exams, blood tests, and urine tests can uncover evidence of this cancer.
If your doctor finds signs of myeloma when you don’t have symptoms, you’ll need to undergo more tests. Your doctor can use the tests below to monitor the progression of the disease and determine whether you need treatment.
Blood and urine tests
Blood and urine tests are used to check for the presence of M proteins. These proteins may occur as a result of multiple myeloma or other conditions. Cancerous cells also make a protein called beta-2 microglobulin, which can be found in your blood. Additionally, blood tests can be used to assess:
- the percentage of plasma cells in your bone marrow
- your kidney function
- your blood cell counts
- your calcium levels
- your uric acid levels
Imaging tests
Healthcare professionals can use the following tests to find out whether multiple myeloma has damaged your bones:
Biopsy
During a biopsy, a doctor removes a small sample of bone marrow, which they send to a laboratory to be checked for cancerous cells. Various tests can determine the types of atypical characteristics in the cells and how quickly the cells are multiplying.
Doctors can use these types of tests to find out whether you have multiple myeloma or another plasma cell condition.
Other plasma cell disorders
- Monoclonal gammopathy of undetermined significance (MGUS): MGUS causes your body to create extra M proteins. It’s usually not a cause for concern, but it requires monitoring because it increases the risk of blood and bone marrow diseases.
- Solitary plasmacytoma: This rare disorder is similar to multiple myeloma, but the plasma cells are located in a single tumor rather than throughout your body. Doctors typically use radiation or surgery to destroy or remove the tumor.
- Light chain amyloidosis: This condition occurs when atypical amyloid proteins called light chains build up in organs such as your kidneys, heart, or liver. It is not curable, but treatments can slow the production of amyloid proteins.
- Waldenstrom macroglobulinemia: Waldenstrom macroglobulinemia is a rare cancer in which your body makes too much of an antibody called immunoglobulin M (IgM). This causes your blood to thicken, making it difficult for your organs to work properly. There’s no cure, but treatment can help relieve symptoms.
Staging of multiple myeloma
If doctors determine that you have multiple myeloma, they’ll use certain tests to find out how far it has progressed. This process is known as staging the cancer. They’ll order tests to check:
- your blood cell counts
- the protein levels in your blood and urine
- the calcium levels in your blood
There are two ways to stage multiple myeloma:
- Durie-Salmon Staging System: This system determines the stage based on the levels of M protein, calcium, and red blood cells, as well as the degree of bone damage.
- Revised International Staging System: This system stages the cancer according to the levels of blood plasma and beta-2 microglobulin.
Both systems divide the condition into three stages, with the third stage being the most severe. Staging helps your doctor determine your outlook and treatment options.
There’s no cure for multiple myeloma, but treatments can help ease the pain, reduce complications, and slow the progression of the disease. Your doctor will recommend treatment only if the disease is getting worse.
Your doctor is not likely to suggest treatment if you don’t have any symptoms. Instead, your doctor will closely monitor your condition for signs that the disease is progressing. Monitoring often involves regular blood and urine tests.
If you need treatment, your doctor may recommend any of the following common options:
Targeted therapy
Targeted therapy medications block a chemical in myeloma cells that destroys proteins, causing the cancer cells to die.
Bortezomib (Velcade) and carfilzomib (Kyprolis) are two drugs that may be used during targeted therapy. Both are given intravenously (directly into a vein) into your arm.
Biologic therapy
Biologic medications use your body’s immune system to attack myeloma cells. The pill form of thalidomide (Thalomid), lenalidomide (Revlimid), or pomalidomide (Pomalyst) is usually used to bolster the immune system.
Lenalidomide is similar to thalidomide but has fewer side effects and appears to be more effective.
Chemotherapy
Chemotherapy is an aggressive form of drug therapy that helps kill fast-growing cells, including myeloma cells. Chemotherapy drugs are often given in high doses, especially before a stem cell transplant. You might receive chemotherapy medications intravenously or take them in pill form.
Corticosteroids
Corticosteroids such as prednisone and dexamethasone are often used to treat myeloma. They can balance your immune system by reducing inflammation in your body, so they’re often effective in destroying myeloma cells. You may take them in pill form or receive them intravenously.
Radiation therapy
Radiation therapy uses strong beams of energy to damage myeloma cells and stop their growth. This type of treatment is sometimes used to kill myeloma cells quickly in a certain area of your body.
For example, doctors may recommend radiation therapy when a cluster of atypical plasma cells forms a tumor called a plasmacytoma that causes pain or destroys bone.
Stem cell transplants
Stem cell transplants involve replacing diseased bone marrow with healthy bone marrow. The healthy marrow comes from either a donor’s stem cells (an allogenic transplant) or your own stem cells (an autologous transplant).
Before the procedure, a healthcare professional will collect blood-forming stem cells from your blood. You’ll then receive radiation therapy or high doses of chemotherapy to treat multiple myeloma.
Once the diseased tissue is destroyed, the stem cells will be infused into your body, where they’ll move into your bones and start rebuilding your bone marrow.
Complementary medicine
Complementary medicine (also called integrative medicine) has become a popular way to cope with the symptoms of multiple myeloma and the side effects of treatment for the condition.
While these therapies cannot treat or cure multiple myeloma, they may ease some of your symptoms.
It’s important to talk with your doctor about these therapies before trying them. You’ll want to make sure they’re right for you and your current health condition. Complementary therapies might include:
- acupuncture
- aromatherapy
- massage
- meditation
- relaxation methods
Multiple myeloma can cause many complications, but they’re usually treatable. For example:
- Back pain can be treated with medications or a back brace.
- Kidney complications are treated with dialysis or a kidney transplant.
- Infections can be treated with antibiotics.
- Bone loss can be slowed or prevented with drug therapy.
- Anemia can be treated with erythropoietin, a medication that stimulates your body to produce more red blood cells.
If you’ve received a multiple myeloma diagnosis, you might find it helpful to take one or more of the following steps:
Learn more about multiple myeloma
Learning more about multiple myeloma can help you make informed decisions about your treatment. You can talk with your doctor about your treatment options and the side effects of each treatment.
The
Try to establish a support system
If you have friends or family members who can lend a helping hand or provide emotional support, let them know that you may need them throughout your treatment. Support groups can also be helpful, and you may be able to find one online.
If you prefer to meet with a support group in person, the
Set reasonable goals
Setting reasonable goals may help you feel a sense of control over your condition so that you stay motivated. Try not to set unattainable goals, which may lead to exhaustion and frustration.
For example, you might not be able to work a full 40 hours per week, but you might be able to work part time.
Focus on your overall health
Do your best to eat nutritious foods and get enough sleep. It can also be helpful to do low intensity exercise, such as walking or yoga, a couple of times per week.
Keeping your body and mind as healthy as possible can help you better cope with the stress and fatigue you may experience with cancer. To make sure you get enough time to rest and recover, try not to overload your schedule.
People who have recently received a diagnosis of multiple myeloma may not experience symptoms for several years. Once the disease has progressed and symptoms occur, most people’s bodies respond well to treatment.
However, serious complications can develop, even after years of successful treatment.
An exact timetable for the disease is difficult to predict. However, during the development of the Revised International Staging System in 2005, researchers found that the
- Stage 1: 62 months (about 5 years)
- Stage 2: 44 months (3 to 4 years)
- Stage 3: 29 months (2 to 3 years)
According to National Cancer Institute data from the years 2015 through 2021, the relative 5-year survival rate for myeloma is
It’s important to keep in mind that these numbers are general estimates based on the outcomes of many people who have had multiple myeloma. Your specific outlook will depend on factors such as your age, your overall health, and how well the cancer responds to treatment.
To learn more about your outlook, you can talk with your doctor about your specific situation.