Signs and Symptoms of Multiple Myeloma

Multiple myeloma symptoms vary and depend on several factors, including the stage and severity of the disease. In early stages, patients may not experience noticeable symptoms. Symptoms and complications of multiple myeloma develop when tumors form in bone marrow, bones, and organs; when abnormal plasma cells interfere with bone marrow function; and/or when the disease causes organ damage.

The primary symptom of multiple myeloma is bone pain. Pain associated with multiple myeloma commonly affects the spine (backbone), ribcage, or hips, and worsens with movement.

Severe, persistent pain in one location may indicate a bone fracture. Bone tissue consists of two types of cells: osteoblasts, which are responsible for bone formation, and osteoclasts, which are responsible for dissolving bone tissue. Multiple myeloma increases the activity of osteoclasts and suppresses the activity of osteoblasts, causing bones to deteriorate and increasing the risk for fractures. The formation of tumors in the bone marrow and bones also contributes to bone pain and fractures.

Other signs of multiple myeloma include low blood counts (cytopenia), high levels of calcium in the blood (called hypercalcemia), and high levels of calcium (called hypercalciuria) or protein (called proteinuria) in the urine. These conditions can affect many organs and body systems and cause a number of symptoms and complications.

Low red blood cell count (called anemia) often causes fatigue, weakness, shortness of breath and pallor (pale skin). Low white cell count (called leukopenia or neutropenia) increases the risk for chronic infections, such as pneumonia and kidney infection (pyelonephritis), and fevers. Low platelet count (called thrombocytopenia) can cause abnormal bleeding, excessive bruising, and other circulation problems (e.g., Raynaud's phenomenon [bluish skin, numbness, often in the fingers and toes, in response to cold or stress], clotting disorders).

Hypercalcemia, hypercalciuria, or proteinuria can cause muscle pain and weakness, increased thirst and urination, gastrointestinal (GI) tract problems (e.g., nausea, vomiting, constipation, weight loss), and kidney (renal) failure.

Multiple myeloma also can cause tumor compression of the spinal cord or nerves, resulting in neurological symptoms. These symptoms include confusion, depression, lethargy (physical and mental sluggishness), headache, nerve disorders (e.g., neuropathy, radiculopathy), vision loss, and bowel and bladder control problems. Spinal cord compression is a medical emergency that requires immediate treatment (e.g., radiation therapy to shrink the tumor) and myeloma patients who experience neurological symptoms should contact their physician right away.

Publication Review By: Stanley J. Swierzewski, III, M.D.

Published: 02 Jul 2009

Last Modified: 14 Sep 2010