Signs and Symptoms in the Final Stages of Multiple Myeloma: What to Expect

Multiple myeloma, a type of blood cancer that affects plasma cells in the bone marrow, can lead to a range of severe complications as it progresses to its final stages. Understanding the signs that may occur near the end of life is crucial for patients, families, and caregivers to ensure comfort and appropriate medical support.

Common Causes of Death in Advanced Multiple Myeloma

One of the leading causes of mortality in late-stage multiple myeloma is infection, particularly respiratory infections such as pneumonia. Due to the compromised immune system caused by both the disease and its treatments, patients become highly vulnerable to bacterial and viral pathogens.

Pulmonary Infections and Respiratory Failure

Lung infections often manifest with high fever, persistent cough, chest tightness, and difficulty breathing. As the condition worsens, patients may develop orthopnea—requiring an upright position to breathe comfortably—and may experience labored, rapid breathing. In severe cases, this can progress to acute respiratory failure, requiring oxygen support or mechanical ventilation. Without intervention, hypoxia can lead to confusion, agitation, and eventually coma.

Septic Shock and Systemic Collapse

When infections spread into the bloodstream, they can trigger sepsis and ultimately septic shock, a life-threatening condition marked by dangerously low blood pressure, organ dysfunction, and altered mental status. This cascade can result in multi-organ failure, significantly contributing to mortality in end-stage myeloma patients.

Cardiovascular Complications and Thrombosis

Patients with multiple myeloma are at increased risk for hyperviscosity syndrome, a condition where abnormal proteins thicken the blood. This elevated viscosity heightens the likelihood of blood clots forming in vital vessels.

In some cases, these clots can lead to serious cardiovascular events such as myocardial infarction (heart attack) or stroke. The presence of chronic inflammation and metabolic imbalances further exacerbates cardiac stress, making heart-related death a plausible scenario even without prior heart disease.

Bleeding and Hemorrhagic Events

Severe bleeding is another potential cause of death in advanced multiple myeloma. Bone marrow suppression reduces platelet production, increasing the risk of hemorrhage. Gastrointestinal bleeding may present as black, tarry stools or vomiting blood, while intracranial hemorrhage can cause sudden neurological decline, seizures, or loss of consciousness.

These bleeding episodes can be rapid and fatal, especially if they occur in critical areas like the brain or digestive tract, and are often difficult to control due to underlying coagulopathies.

Metabolic and Organ-Related Crises

Hypercalcemia and Its Dangers

Elevated calcium levels—known as hypercalcemia—are common in late-stage myeloma due to extensive bone breakdown. Symptoms include extreme fatigue, nausea, constipation, confusion, and cardiac arrhythmias. In severe cases, hypercalcemia can trigger cardiac arrest or sudden death, sometimes occurring during sleep.

Organ Damage and Amyloidosis

Some patients develop amyloidosis, a condition where abnormal proteins build up in organs such as the heart, kidneys, and liver. This infiltration impairs organ function and can lead to sudden cardiac death or renal failure. Amyloid-related heart damage may go unnoticed until it reaches a critical stage, making it a silent but deadly complication.

Ultimately, the end-of-life phase in multiple myeloma is often marked by a combination of systemic failures. While each patient's journey is unique, awareness of these potential symptoms allows for better palliative care planning, symptom management, and emotional preparedness for loved ones.