The specific symptoms, age of onset, and rate of progression of multiple myeloma varies from patient to patient. Some affected individuals will not exhibit any symptoms (asymptomatic). Multiple myeloma may progress to cause life-threatening complications. It is important to note that affected individuals will not have all the symptoms listed below.
The most common symptom associated with multiple myeloma is bone pain, usually of the lower back or ribs. In most patients, movement worsens the pain, which may be mild, moderate or severe. Affected individuals are usually more susceptible to fractures than the general population and may experience repeated fractures of affected bones. The bones of the spine may become involved, potentially collapsing and resulting in spinal cord compression. Compression of the spinal cord results in pain, Weakness and numbness in the arms and legs.
Another possible sign of multiple myeloma is an elevated level of calcium in the blood, a condition called hypercalcemia. This occurs because damage to bones often results in the release of calcium into the bloodstream. Abnormally high levels of calcium may result in nausea, lack of appetite, fatigue, abdominal pain, muscle Pain and weakness, excessive thirst, and/or confusion.
Overproduction of plasma cells may also hinder the production and decrease the effectiveness of other cells of the body resulting in a variety of symptoms. Affected individuals may experience low levels of circulating red blood cells (anemia) resulting in weakness, fatigue, dizziness, shortness of breath, and lack of color (pallor). Affected individuals may also experience low levels of cells that assist in clotting (platelets), a condition known as thrombocytopenia. Symptoms associated with thrombocytopenia include Abnormal bleeding episodes that often result in purplish discoloration of the skin resulting from bleeding (hemorrhaging) of small blood vessels near the surface of the skin (purpura). Rarely, affected individuals may experience repeated nosebleeds (epistaxis).
Affected individuals may also have low levels or reduced effectiveness of white blood cells, which weakens the immune system and results in a higher susceptibility than the general population to developing recurrent bacterial infections. The most common infection is pneumonia. In some patients, recurrent infections may be the first apparent symptom of multiple myeloma.
Individuals with multiple myeloma may also develop kidney abnormalities. In some patients, hypercalcemia may cause kidney damage. Abnormal proteins found in the blood or urine (M-proteins), which are produced by myeloma cells, may cause kidney damage (myeloma kidney). Kidney abnormalities may develop slowly or rapidly, and may eventually progress to cause kidney (renal) failure.
Rarely, individuals with multiple myeloma may have an abnormally large liver (hepatomegaly) or spleen (splenomegaly).Rarely, multiple myeloma may occur in association with other disorders. The three most common disorders that may occur in association with multiple myeloma include hyperviscosity syndrome, cryoglobulinemia, or amyloidosis.
Hyperviscosity syndrome is characterized by the blood becoming abnormally thick and sticky due to the abnormal accumulation of M-proteins in the blood. As a result blood flow is slowed. Hyperviscosity syndrome may cause headaches, nose bleeding, fatigue, frequent bruising, gastrointestinal bleeding, and vision abnormalities such as disease of the retina (retinopathy). Cryoglobulinemia is a rare disorder that occurs due to the accumulation of abnormal proteins (cryoglobulins) in the bloodstream. These proteins thicken or gel on exposure to cold. In some patients there are no symptoms and in others a variety of symptoms may develop. The most common symptoms are joint Pain (arthralgia), Pain and numbness in the fingers and toes in response to cold (Raynaud’s phenomenon), weakness, and purpura.
Amyloidosis is a rare disorder characterized by the abnormal accumulation of a fibrous protein (amyloidosis) in tissues of the body. The excessive accumulation of amyloid causes an affected organ to malfunction. (For more information on this disorder, see the Related Disorders section below.)