Clinical features of myeloma

The most common presenting signs and symptoms of myeloma are bone pain (or fractures), fatigue, recurring infections, kidney damage, peripheral neuropathy and anaemia,. However, not all patients will have symptoms and sometimes a diagnosis is only made after an incidental finding, for example, from the results of routine or other tests.

Myeloma bone disease

Bone pain, loss of height and pathological fractures are all features of myeloma bone disease. Other complications associated with myeloma bone disease include generalised osteoporosis (decreased bone mineral density), lytic lesions (holes in the bone) and compression fractures of the vertebrae, which can lead to back pain and neurological symptoms due to spinal cord compression. Bone destruction can also lead to hypercalcaemia, which can cause dehydration, drowsiness, confusion, constipation and renal damage.

Myeloma bone disease is covered in greater detail in Module 8.

Anaemia

Anaemia, a reduction in the number of red blood cells and therefore haemoglobin (Hb) concentration in the blood, is frequently seen in myeloma patients. This can occur for a number of different reasons related to the myeloma itself and/or its treatments. For example, the presence of myeloma cells in the bone marrow can actively suppress red blood cell production and therefore reduce the concentration of haemoglobin. This means there is a reduction in the amount of oxygen reaching the tissues and organs, ultimately leading to general feelings of weakness, fatigue and malaise.

Immune suppression

Bacterial and viral infections are common, due both to the disease process itself and the treatments for it. Infection as a result of the myeloma itself is due in part to the lowered level of normal immunoglobulins, thus leading to a compromised immune function. The risk of infection is also increased because of the infiltration of myeloma cells which can actively suppress white blood cell production.

Renal dysfunction

Renal damage is a common complication of myeloma. At diagnosis, around 20% of patients present with acute renal failure (defined as less than 15% renal function) as a result of myeloma kidney disease. Renal impairment can also evolve over time with a further 40% of patients affected by it during the course of their myeloma. It is most commonly due to damage caused by free light chains (BJP), but other factors such as hypercalcaemia, infection and dehydration can also affect kidney function.

Anaemia, immune suppression and renal function are covered in greater detail in Module 7 – Management of disease and treatment-related symptoms and complications in myeloma.