There are many ways to manage symptoms and side effects resulting from multiple myeloma. It’s important to discuss the details of your experience with your doctor to determine what additional support is needed. These are some common changes and issues that can arise in people with multiple myeloma, as well as ways to mitigate them.
Symptoms
Multiple myeloma symptoms vary from person to person, with the early stages of multiple myeloma often presenting no visible symptoms or signs. When present, the symptoms of multiple myeloma may be vague or similar to those of other conditions. If your doctor suspects you may have multiple myeloma, they may run a number of different urine and blood tests to confirm the diagnosis.
Side effects
Just as treatment plans are uniquely personalized, multiple myeloma therapies can cause varying side effects from person to person. It’s important to regularly communicate feelings and experiences with your doctor during your treatment journey.
Symptoms
Bone damage
Multiple myeloma leads to bone loss in two ways. First, multiple myeloma cells gather to form masses in the bone marrow that may disrupt the normal structure of the surrounding bone. Second, multiple myeloma cells secrete substances that interfere with the normal process of bone repair and growth.
About 85% of people with multiple myeloma have some type of bone damage (osteolytic lesions) or loss (osteoporosis). The most commonly affected areas are the spine, pelvis and rib cage.
With weakened bones, people with multiple myeloma often experience bone pain and have an increased risk for fracture. They are also at risk for spinal cord compression, a medical emergency that requires immediate treatment in order to avoid long-term damage.
Additionally, bone destruction can cause an increased level of calcium in the bloodstream, a condition called hypercalcemia, which can be a serious problem if not treated immediately.
Common ways to manage bone damage in people with multiple myeloma include supplementation with calcium and vitamin D, exercise, bisphosphonates and other medications, orthopedic interventions and low-dose radiation therapy.
About 85% of people with multiple myeloma have some type of bone damage (osteolytic lesions) or loss (osteoporosis). The most commonly affected areas are the spine, pelvis and rib cage.
With weakened bones, people with multiple myeloma often experience bone pain and have an increased risk for fracture. They are also at risk for spinal cord compression, a medical emergency that requires immediate treatment in order to avoid long-term damage.
Additionally, bone destruction can cause an increased level of calcium in the bloodstream, a condition called hypercalcemia, which can be a serious problem if not treated immediately.
Common ways to manage bone damage in people with multiple myeloma include supplementation with calcium and vitamin D, exercise, bisphosphonates and other medications, orthopedic interventions and low-dose radiation therapy.
Fatigue
Fatigue in multiple myeloma patients is related to decreased blood cell counts. In particular, a low red blood cell count, a condition known as anemia, can cause fatigue. Red blood cells carry oxygen throughout the body to organs and muscles; when the number of red blood cells is decreased, tissues receive decreased oxygen, resulting in the feeling of fatigue. In addition, a low white blood cell count can lead to frequent infections, which can contribute to fatigue.
Impaired kidney function and kidney failure
In people with multiple myeloma, excess M protein and calcium in the blood overwork the kidneys as they filter blood. As a result, the kidneys may fail to function normally. If the impaired kidney function is so severe that the kidneys are unable to sufficiently do their job of filtering metabolic waste from the blood, it results in a complication called kidney failure.
More than half of people with multiple myeloma will experience a decrease in their kidney (or “renal”) function at some point in the course of their disease.
A decrease in the amount of urine is one sign of kidney problems, so let your doctor know if you experience any changes in urination. If your doctor suspects impaired kidney function, he or she will likely perform blood tests to detect certain proteins (such as creatinine) that may indicate reduced kidney function.
Staying well hydrated is one way to manage impaired kidney function. Your doctor may also advise you to avoid anti-inflammatory drugs (such as Advil, Motrin and Aleve). Depending on the severity of your impaired kidney function, you may undergo plasmapheresis or dialysis.
More than half of people with multiple myeloma will experience a decrease in their kidney (or “renal”) function at some point in the course of their disease.
A decrease in the amount of urine is one sign of kidney problems, so let your doctor know if you experience any changes in urination. If your doctor suspects impaired kidney function, he or she will likely perform blood tests to detect certain proteins (such as creatinine) that may indicate reduced kidney function.
Staying well hydrated is one way to manage impaired kidney function. Your doctor may also advise you to avoid anti-inflammatory drugs (such as Advil, Motrin and Aleve). Depending on the severity of your impaired kidney function, you may undergo plasmapheresis or dialysis.
Low blood cell count
A common characteristic of multiple myeloma is low blood cell count. This happens due to the interference of cancerous cells in the production of normal blood cells. Low blood cell count contributes to a wide range of multiple myeloma complications:
*Normal ranges may vary.
- Low blood count of the red blood cells usually results in anemia.
- Low blood count of the white blood cells impairs the immune system.
- A reduction in blood platelets (thrombocytopenia) can lead to blood clotting issues like increased bleeding.
| Count | Definition | Normal Range* |
| Erythrocytes (RBCs) | Number of red blood cells in the blood. Red blood cells bring oxygen from the lungs to the various tissues in the body and carry carbon dioxide back to the lungs. Low numbers of red blood cells or low hemoglobin or hematocrit indicate anemia, which can cause physical and mental fatigue. | Female 3.90-5.03 x 1012/L Male 4.32-5.72 x 1012/L |
| Hemoglobin (Hb) | Oxygen-carrying substance in red blood cells | Female 12.0 – 15.5 g/dL Male 13.5 – 17.5 g/dL |
| Hematocrit (HCT) | Percentage of red blood cells in the blood | Female 34.9 – 44.5% Male 38.3 – 50.0% |
| Leukocytes (WBCs) | Number of white blood cells in the blood; counts or percentages of the individual types of blood cells are also provided. White blood cells help fight infection and remove harmful substances from the body. A low number of white cells can increase the possibility of infection. | Total 3.5 - 10.5 x 109/L Neutrophils 1.7 - 7.0 Monocytes 0.2 – 1.0 Lymphocytes 1.0-3.0 Basophils 0.02 - 0.1 Eosinophils 0.02 - 0.5 |
| Platelet | Number of platelets in the blood. Because platelets help blood to clot, low counts can lead to excessive bleeding. | 150 - 450 x 109/L |
Impaired immune function
Although multiple myeloma leads to an increased level of antibodies, the antibodies produced by multiple myeloma cells are ineffective — and they crowd out the healthy cells that produce functional, disease-fighting antibodies. By impairing the immune system in this way, multiple myeloma reduces the body’s ability to prevent or fight off infections.
As a result of this impaired immune function, people with multiple myeloma are more susceptible to frequent infections. In fact, they are about 15 times more likely to get an infection than people without multiple myeloma.
Preventive steps can be taken to reduce your risk of infection:
As a result of this impaired immune function, people with multiple myeloma are more susceptible to frequent infections. In fact, they are about 15 times more likely to get an infection than people without multiple myeloma.
Preventive steps can be taken to reduce your risk of infection:
- Wash your hands.
- Cook food thoroughly.
- Wash fruits and vegetables.
- Avoid contact with people who show signs of being sick.
- Protect the skin from scrapes and cuts.
- Keep current with flu and pneumonia vaccines.
- To further reduce your risk of infection, your doctor may use medications such as intravenous antibody therapy (immunoglobulin IgG), antifungal medications, colony-stimulating factors and preventive shingles treatments or antibiotics.
Anemia
In people with multiple myeloma, the growing number of cancerous cells can interfere with the production of all types of blood cells. Decreased production of red blood cells can result in a complication called anemia. Certain multiple myeloma treatments can contribute to anemia as well.
Anemia is typically defined as an abnormally low hemoglobin (Hb) level. Hemoglobin, a substance found within red blood cells, carries oxygen from the lungs to the tissues in the body.
Normal hemoglobin levels are:
Anemia can cause symptoms such as weakness, fatigue, shortness of breath and dizziness. Over 60% of multiple myeloma patients have anemia at the time they are diagnosed, and most remaining patients become anemic during the course of their disease.
A number of supportive therapies — including medications called red blood cell growth factors or supplementation with iron, folate or vitamin B12 — may be used to treat anemia in people with multiple myeloma. For people with severe anemia, blood transfusions may be needed.
Anemia is typically defined as an abnormally low hemoglobin (Hb) level. Hemoglobin, a substance found within red blood cells, carries oxygen from the lungs to the tissues in the body.
Normal hemoglobin levels are:
- 12.0 to 15.5 g/dL for women
- 13.5 to 17.5 g/dL for men
| Severity of Anemia | Hemoglobin Level (g/dL) |
| Mild | 10 or more |
| Moderate | 8 – 10 |
| Severe | 6.5 – 8 |
| Life-Threatening | Less than 6.5 |
A number of supportive therapies — including medications called red blood cell growth factors or supplementation with iron, folate or vitamin B12 — may be used to treat anemia in people with multiple myeloma. For people with severe anemia, blood transfusions may be needed.
Hypercalcemia
Bone destruction in people with multiple myeloma can release excess calcium into the bloodstream, resulting in a condition known as hypercalcemia.
When severe, hypercalcemia can result in coma or cardiac arrest, so it’s very important to identify and treat it quickly. Let your doctor know right away if you experience any of the following symptoms:
When severe, hypercalcemia can result in coma or cardiac arrest, so it’s very important to identify and treat it quickly. Let your doctor know right away if you experience any of the following symptoms:
- Loss of appetite
- Increased thirst
- Increased urination
- Restlessness
- Difficulty in thinking or confusion
- Nausea and vomiting
Side effects
Blood clots
Blood clots can be caused by certain multiple myeloma medications, specifically the immunomodulatory drugs Revlimid® (lenalidomide) and Pomalyst® (pomalidomide). The risk of clots is higher when these medications are prescribed in combination with steroids, such as dexamethasone.People who are newly diagnosed or who have had blood clots in the past are at particularly high risk. Other risk factors for blood clots include older age, family history, other medical conditions, obesity and long periods of sitting or lying still.
Your doctor will assess your risk of developing blood clots and may prescribe blood thinners to reduce the risk. Aspirin is recommended to most patients, while low-molecular-weight heparin is prescribed to those at greater risk. In some cases, additional medications may be recommended as well. You can also help prevent blood clots by avoiding long periods of inactivity.
Your doctor will assess your risk of developing blood clots and may prescribe blood thinners to reduce the risk. Aspirin is recommended to most patients, while low-molecular-weight heparin is prescribed to those at greater risk. In some cases, additional medications may be recommended as well. You can also help prevent blood clots by avoiding long periods of inactivity.
Peripheral neuropathy
Peripheral neuropathy, or the symptoms that arise from peripheral nerve damage, is commonly encountered by multiple myeloma patients and can be caused by certain treatments.
The experience of peripheral neuropathy varies from person to person but can be described as pain, tingling (“pins and needles” sensation), burning, numbness, reduced sensation, inability or struggling to pick up small objects, trembling, tripping or stumbling when walking or sensitivity to temperature. It often affects the extremities first, starting in the toes or fingers and moving inward to the ankles or wrists.
If you experience peripheral neuropathy, your doctor will determine the best way to manage it based on the underlying cause — whether that is your multiple myeloma itself, a particular treatment you are receiving or an unrelated condition you may have, such as diabetes. Peripheral neuropathy is a common side effect of the multiple myeloma treatments Velcade® (bortezomib), and less frequently, Ninlaro® (ixazomib). With Velcade, peripheral neuropathy can often be decreased by using dose modifications, such as a once weekly dosing schedule or subcutaneous instead of intravenous injection. Peripheral neuropathy can also be managed by certain medications such as gabapentin, pregabalin and others.
To help cope with peripheral neuropathy, try to avoid things that make it worse, like extreme (hot or cold) temperatures or tight-fitting clothing or shoes. Avoid alcohol and use handrails, a walker or a cane to help you maintain your balance when walking. Foot massages can be helpful, as can physical or occupational therapy
The experience of peripheral neuropathy varies from person to person but can be described as pain, tingling (“pins and needles” sensation), burning, numbness, reduced sensation, inability or struggling to pick up small objects, trembling, tripping or stumbling when walking or sensitivity to temperature. It often affects the extremities first, starting in the toes or fingers and moving inward to the ankles or wrists.
If you experience peripheral neuropathy, your doctor will determine the best way to manage it based on the underlying cause — whether that is your multiple myeloma itself, a particular treatment you are receiving or an unrelated condition you may have, such as diabetes. Peripheral neuropathy is a common side effect of the multiple myeloma treatments Velcade® (bortezomib), and less frequently, Ninlaro® (ixazomib). With Velcade, peripheral neuropathy can often be decreased by using dose modifications, such as a once weekly dosing schedule or subcutaneous instead of intravenous injection. Peripheral neuropathy can also be managed by certain medications such as gabapentin, pregabalin and others.
To help cope with peripheral neuropathy, try to avoid things that make it worse, like extreme (hot or cold) temperatures or tight-fitting clothing or shoes. Avoid alcohol and use handrails, a walker or a cane to help you maintain your balance when walking. Foot massages can be helpful, as can physical or occupational therapy
Gastrointestinal problems
Many medications for multiple myeloma can cause gastrointestinal side effects, including constipation, diarrhea, nausea and vomiting. While some people find it embarrassing to discuss these problems, rest assured that your doctors and nurses are used to discussing them and can often easily treat them.
Your doctor may prescribe a stool softener or laxative to help relieve constipation. Additionally, a diet high in fiber with plenty of bran-based cereals, fruits, vegetables, lentils and whole grains can help. Drinking plenty of water is important, and hot drinks like coffee or tea can help stimulate a bowel movement. Gentle exercise, such as walking or swimming, can also be helpful.
If you experience severe diarrhea (more than six loose stools per day for two days), let your doctor know right away. He or she will recommend an over-the-counter or a prescription antidiarrheal medication and may advise you to take a fiber supplement. It’s important to stay hydrated when experiencing diarrhea, so drink plenty of water and avoid coffee and alcohol. Eating small, light meals slowly throughout the day can be helpful.
Drugs called antiemetics are used to treat nausea and vomiting. Depending on the multiple myeloma treatment you’re receiving, your doctor may even prescribe an antiemetic drug to stop nausea and vomiting before it starts. Drinking lots of fluids and eating small meals throughout the day can also help manage nausea and vomiting.
Constipation
Constipation occurs when bowel movements are difficult and infrequent (less than three per week). Stools may be dry, hard and painful.Your doctor may prescribe a stool softener or laxative to help relieve constipation. Additionally, a diet high in fiber with plenty of bran-based cereals, fruits, vegetables, lentils and whole grains can help. Drinking plenty of water is important, and hot drinks like coffee or tea can help stimulate a bowel movement. Gentle exercise, such as walking or swimming, can also be helpful.
Diarrhea
Diarrhea is defined as frequent (more than three per day) loose or watery stools.If you experience severe diarrhea (more than six loose stools per day for two days), let your doctor know right away. He or she will recommend an over-the-counter or a prescription antidiarrheal medication and may advise you to take a fiber supplement. It’s important to stay hydrated when experiencing diarrhea, so drink plenty of water and avoid coffee and alcohol. Eating small, light meals slowly throughout the day can be helpful.
Nausea and vomiting
Nausea is the feeling of being sick to your stomach or queasy with an urge to vomit, and vomiting is actually expelling stomach contents. Dry heaving is the sensation of vomiting without throwing up. These are all commonly experienced by people with multiple myeloma, due to the disease itself or to certain treatments.Drugs called antiemetics are used to treat nausea and vomiting. Depending on the multiple myeloma treatment you’re receiving, your doctor may even prescribe an antiemetic drug to stop nausea and vomiting before it starts. Drinking lots of fluids and eating small meals throughout the day can also help manage nausea and vomiting.
Decreased blood counts
Many myeloma therapies can cause a decrease in blood cell counts. Proteasome inhibitors such as Velcade and Kyprolis, immunomodulatory drugs such as Revlimid and Pomalyst, and also antibodies such as Empliciti can decrease the numbers of red blood cells, white blood cells and/or platelets. Blood cell counts are carefully monitored by your doctor and if they become too low, therapy may be delayed, or dose adjustments may be made, until numbers increase to normal levels. Maintaining good nutrition is important in helping blood counts stay in the normal range. Your doctor may also prescribe growth factors such as erythropoietin, to stimulate red blood cell production, and/or colony stimulating factors such as G-CSF or GM-CSF, to stimulate white blood cell production.
