Clinical features

Symptoms depend on the type and extent of myeloma; the following refers to people with the common diffuse type of multiple myeloma. Someone with myeloma may have few specific symptoms or a number of the symptoms described below, most will have bone pain.

There may be symptoms related to damage to the other stem cells in the bone marrow because they are crowded out by the abnormal plasma cells including:

• Anaemia because too few red blood cells are produced – anaemia causes fatigue and reduced exercise tolerance. Regular blood transfusions or erythropoietin injections may be needed until treatment stabilises disease.
• Repeated infections - because not enough infection fighting white blood cells are produced
• Abnormal bruising after minor injury because not enough platelets are produced

There may be symptoms related to erosion of bones by plasma cells:

• Pain in the bones especially the back – this is the commonest symptom and may be severe
• Pathological fractures – fractures of the vertebral bodies, which are present in 50% of patients at diagnosis, may result in spinal cord compression in some patients
• Pathological fractures of the long bones in the limbs may also occur, needing orthopaedic surgery and fixation.

High blood levels of calcium (hypercalcaemia) may result from myeloma bone disease and can cause a variety of symptoms, including-:

• Thirst
• Nausea and vomiting
• Passing a lot of urine
• Drowsiness and in severe cases coma and death
• Hypercalcaemia is an emergency and will be treated in hospital

There may be symptoms related to damage to organs by the abnormal proteins circulating in the blood:

• Kidney failure –immunoglobulin light chains may damage kidney tubules and commonly lead to kidney failure in myeloma
• Nerve damage may rarely result from inflammation of peripheral nerves by the myeloma protein, causing numbness, altered sensation, weakness and problems with balance and movement.
• Amyloidosis – the symptoms of this disease are caused by damage to organs by blood proteins deposited in tissues: the cause in myeloma is deposition of the abnormal light chains in the tissues. Deposited proteins eventually damage organs such as the heart (causing heart failure), liver, nervous system, the gastrointestinal tract, and kidneys. Symptoms are usually vague and may include tiredness, dizziness, reduced appetite, diarrhoea and shortness of breath.

Symptoms of the variant forms of myeloma

• Isolated Plasmacytoma of Bone – usually the symptom is bone pain and tenderness at the site of the plasmacytoma. Common sites are the spine and long bones of the arms and legs
• Solitary Extramedullary Plasmacytoma – the usual symptom is a lump somewhere in the body, most commonly in the head or neck. If it is in the throat e.g. in the tonsil or the back of the nose there may be difficulty swallowing. These can occur anywhere including the bowel, bladder, breast etc.
• Monoclonal Gammopathy of Undetermined Significance (MGUS) –a low level of paraprotein is present in the blood, but there are no signs of organ damage or symptoms of disease and no treatment is required. A small proportion of people with MGUS will go on to develop multiple myeloma each year.

Amended February 2009