Multiple myeloma is a blood cancer that occurs when healthy plasma cells become abnormal, leading to the production of abnormal antibodies. This change can result in a range of medical problems that affect the bones, kidneys, blood, and the immune system.

Complications in the Bone Marrow

Bone marrow produces white and red blood cells and platelets. When myeloma cells fill the bone marrow, the production of these blood cells is compromised, leading to anemia, a common symptom of multiple myeloma that is often noticeable in the early stages of the disease.

Bone marrow cells play a crucial role in maintaining bone health by breaking down old bone and stimulating new bone growth. However, the presence of multiple myeloma cells interferes with these processes by:

1. Stimulating the cells that break down bone (osteoclasts).
2. Suppressing cells that build new bone (osteoblasts).

The result of this interference is bone fractures, bone pain, and the release of calcium from the bones into the blood. 

Complications in the Rest of the Body

The release of calcium from bones into the bloodstream can result in hypercalcemia. This is higher than normal level of calcium in the blood. Hypercalcemia can cause the following symptoms:

• loss of appetite
• nausea
• thirst
• fatigue
• muscle weakness
• restlessness  
• confusion  

M-protein can also interfere with blood clotting or circulation, potentially causing other organ or tissue damage (e.g. damage to nerve tissue). 

Medical Problems Related to Myeloma

Upon diagnosis, the management of your myeloma is the top priority until remission has been achieved, except in cases of emergency medical problems. There are medical problems that require immediate attention before beginning systemic therapy for myeloma. Urgent medical probelms in myleoma included the following:

• compromised bony structures,
• nerve damage,
• infections, and
• kidney disease.

Along with the immediate management of the complications, a prompt consultation with a myeloma specialist is essential to ensure that any treatment of an urgent medical problem does not limit your options for the treatment of myeloma. For example, radiation therapy to shrink a plasmacytoma (tumor) that is pressing on nerve tissue must be weighed carefully against a surgical option, because radiation therapy may damage the bone marrow, thereby limiting your options for myeloma therapy.

Bony complications and nerve damage

Bony areas of lytic lesions, fractures, or collapsed vertebrae can cause bone pain and nerve or spinal cord damage. The vertebrae (bony segments of the spinal column) are often affected by myeloma.

Because the spinal cord runs through the vertebrae, painful vertebral fractures may occur. In addition, myeloma tumors growing in the vertebrae can also press on spinal nerves. Nerve compression is not uncommon. Loss of motor nerves can cause paralysis.

Vertebral compression fractures (VCF) are a serious complication of myeloma. Treatments of VCFs include analgesics to relieve pain, bracing to provide temporary stability, and minimally invasive surgical procedures such as vertebral augmentation and balloon kyphoplasty. For more information about VCFs, read the IMF’s publication Understanding Treatment of Myeloma-Induced Vertebral Compression Fractures.

Infection

The growth of myeloma cells reduces the number and activity of normal plasma cells that produce antibodies against infection, leaving the patient susceptible to infection. Furthermore, as the marrow is taken over by myeloma cells, the production of normal cells, including infection-fighting white blood cells, can be reduced in number. Serious infections may occur, requiring immediate intervention.

Kidney damage or failure

Renal (kidney) damage or failure can cause dramatic fatigue and weakness, mental confusion, and decrease or lack of urination. Treatments range from hydration to dialysis.

Blood clots and thromboembolic events

Clotting events may be medical emergencies. Treatment is based on patient risk factors, location of the clot, and potential impact on local and distant tissues

Learn More About Multiple Myeloma

The International Myeloma Foundation offers extensive information on multiple myeloma. You can visit our online resource library and download the information you need free of charge. You are also welcome to contact our InfoLine to talk with one of our compassionate professionals, they are well-equipped to answer your questions. 
 

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