Multiple Myeloma: Recognizing the Key Symptoms and Systemic Effects

Multiple myeloma, a malignant disorder originating in plasma cells, primarily affects older adults and is characterized by widespread systemic involvement. This cancer disrupts normal bone marrow function and leads to a cascade of complications affecting bones, blood, kidneys, and other organs. Early recognition of symptoms is crucial for timely diagnosis and effective management.

Common Hematologic Manifestations

One of the hallmark features of multiple myeloma is anemia, specifically normocytic anemia, where red blood cells are normal in size but reduced in number. This develops due to the infiltration of malignant plasma cells in the bone marrow, which suppresses healthy blood cell production. Patients often report persistent fatigue, weakness, and dizziness as a result of decreased oxygen-carrying capacity in the bloodstream.

Skeletal Complications and Bone Pain

Bone pain is another prevalent symptom, typically caused by lytic (solvent-like) bone destruction. These lesions most frequently occur in flat bones such as the skull, ribs, pelvis (including iliac bones), and vertebrae. The structural weakening of bones can lead to compression fractures or pathologic fractures—fractures that happen with minimal or no trauma. Back pain, especially in the lumbar or thoracic spine, may signal vertebral involvement and should prompt immediate medical evaluation.

Kidney and Urinary Tract Involvement

Renal dysfunction is common in multiple myeloma patients. Excess production of monoclonal immunoglobulin light chains (also known as Bence Jones proteins) can damage the kidneys, leading to proteinuria—often visible as foamy urine. Over time, this may progress to impaired kidney function or even renal failure if not addressed promptly.

Hypercalcemia and Its Effects

As bone breakdown accelerates, calcium is released into the bloodstream, potentially causing hypercalcemia. Elevated calcium levels can manifest as excessive thirst, frequent urination, constipation, confusion, and in severe cases, cardiac arrhythmias. Monitoring electrolyte levels is therefore essential during patient assessment.

Cutaneous and Neurological Symptoms

Some individuals experience pruritus (skin itching), which may be linked to abnormal protein deposition or altered immune activity. Additionally, nerve-related symptoms such as numbness, tingling, or peripheral neuropathy can occur, either from direct amyloid infiltration or as a side effect of treatment.

Hyperviscosity Syndrome and Coagulation Abnormalities

The overproduction of monoclonal proteins thickens the blood, resulting in hyperviscosity syndrome. This condition increases the risk of both bleeding and clotting events due to impaired platelet function and disrupted coagulation pathways. Clinically, patients may present with easy bruising, nosebleeds, or gum bleeding despite elevated clotting factors.

Thrombotic Risks and Organ-Specific Presentations

Thrombosis is a serious concern, particularly in the setting of hyperviscosity and certain myeloma treatments. Deep vein thrombosis (DVT) may present as unilateral leg swelling, pain, warmth, and redness—typically in the lower extremities. If a clot travels to the lungs, it can cause pulmonary embolism, marked by sudden chest pain, shortness of breath, coughing, and sometimes hemoptysis (coughing up blood).

In summary, multiple myeloma presents with diverse clinical signs that span multiple body systems. Awareness of these manifestations—including unexplained bone pain, fatigue, foamy urine, and neurological or vascular complications—can significantly improve early detection and outcomes. Anyone experiencing persistent or worsening symptoms, especially in the context of advanced age, should seek comprehensive hematological evaluation.