Multiple Myeloma Symptoms

Written by Barbara Brody, Lori M. King, PhD
Medically Reviewed by Shruthi N, MD on November 22, 2024
10 min read

Multiple myeloma is a rare type of blood cancer that affects the plasma cells in your bone marrow. Your plasma cells are like little factories that make specific proteins called antibodies. Antibodies help protect you from foreign invaders like bacteria, fungi, and viruses. When you have multiple myeloma, one of these plasma cells starts to reproduce out of control. This plasma cell will keep reproducing until it fills your bone marrow and swamps out the other cells.

Because of this, your bone marrow can't make as many of the other blood cells you need: red blood cells, white blood cells, and platelets. And the plasma cell that is growing out of control makes defective proteins (sometimes called M-proteins) that flood into your bloodstream. Due to this, you may get symptoms of high blood calcium, kidney damage, anemia, and bone damage. Some common symptoms include:

  • Brittle bones that hurt and break more easily
  • Pain, weakness, and numbness or tingling in your arms and legs
  • Extreme tiredness or fatigue
  • Nausea and vomiting
  • Fever and infections
  • Easy bruising, nosebleeds, bruising, and bleeding gums

Unfortunately, these symptoms could be caused by different conditions unrelated to cancer, which is part of the reason multiple myeloma can be hard to diagnose.

Because this is cancer of your blood, there won't be a lump you could feel — although you may have sore spots on your bones. Often, you won't know you have multiple myeloma until your doctor runs a routine complete blood count. In it's earliest stages, you may or may not have any symptoms.

Multiple myeloma is usually diagnosed when people are aged between 65 and 74 years, and men and people assigned male at birth are most likely to get it.

Learn more about the potential symptoms you may expect if you have multiple myeloma.

It can be challenging to diagnose multiple myeloma early because it doesn't usually cause any symptoms until it's advanced enough for you to have organ damage. And if it does cause symptoms, they tend to be things that can be caused by a lot of different conditions. If you do have symptoms, they may include:

  • Bone pain. This may feel like dull or achy pain from deep in your body. It may hurt to move or use that part of your body. The skin over your affected bone may feel tender. The pain may spread out from one spot, but you'll likely be able to feel one clear spot that's the most painful or tender.
  • Weakness or feelings of numbness in your arms and legs. This can be a symptom of bone problems in your spine.
  • Fatigue and weakness. These can be symptoms of anemia.
  • Nausea and vomiting. These may be a symptom of high calcium levels in your blood.
  • Extreme thirst and loss of appetite. These are also symptoms of high calcium levels.
  • Unexplained weight loss.
  • Unexplained fever. This can be a symptom of infection.
  • Easy bruising and bleeding. These can happen if you don't have enough platelets to help your blood clot well. Having abnormal plasma cells — as you do with multiple myeloma — can keep your bone marrow from making enough platelets.
  • Having brain fog or feelings of confusion.

These symptoms can be caused by a number of conditions, most of which aren't serious. But if you have several of them at the same time or they've been going on for a couple of weeks, it's important to get checked out by your doctor.

In the past, you had to have organ damage, as shown by CRAB criteria, to be diagnosed with multiple myeloma. CRAB is an acronym that stands for the signs on blood tests and imaging your doctor would look for. These include:

C = High calcium levels in your blood (also called hypercalcemia). This is defined as a serum calcium level greater than 2.75 millimoles per liter (11 milligrams per deciliter) or greater than 0.25 millimoles per liter (or 1 milligram per deciliter) above the upper limit of normal, according to your lab's cutoff.

R = Renal (kidney) insufficiency. This is defined as a serum creatinine level greater than 177 micromoles per liter (2 milligrams per deciliter) or a creatinine clearance rate of less than 40 milliliters per minute.

A = Anemia. This is defined as a hemoglobin value of less than 100 grams per liter or less than 20 grams per liter below the lowest limit of normal, according to your lab's cutoff.

B = Bone pain or lesions. You may have pain in any bone, but it's most likely in your back, hips, or skull. Using X-rays or CT or PET/CT scans, your doctor would look for breaks and places of weakness in your bones.

Not everyone who has multiple myeloma meets all four CRAB criteria. And people tend to have better outcomes on treatment when they are treated before this organ damage happens.

So to help more people get diagnosed and treated earlier, the Myeloma Working Group has developed updated criteria for diagnosis of active multiple myeloma. These new criteria are generally how doctors diagnose multiple myeloma now. They include:

  • Greater than 10% of clonal bone marrow plasma cells on bone biopsy or extramedullary plasmacytoma
  • Presence of one or more of the previous CRAB features or the following myeloma-defining events:

60% or more clonal plasma cells when your doctor looks at your bone marrow.

Your bone marrow contains cells called B cells. Your B cells make proteins called antibodies that your immune system needs to help protect you from invaders. When a B cell learns about a new substance to protect you from (called an antigen), it makes a plasma cell. This plasma cell's job is to keep producing the antibody that the original B cell learned about. That way, your immune system can continue to protect you from all the invaders you've come into contact with.

In the case of multiple myeloma, one of your plasma cells divides repeatedly. Each of these cells is genetically identical to the original cell and is called a clone. These clonal cells make one single antibody called a monoclonal antibody (may also be called M-protein, monoclonal immunoglobulin, M-spike, or paraprotein). Because much of your bone marrow only makes one type of antibody, you have an raised risk of infection. And because these clonal cells swamp out other cells in your bone marrow, you're also at a raised risk of organ damage from the raised number of plasma cells that invade your organs, like your kidneys and bones.

A ratio of 100 or greater of involved to uninvolved free light chain in your blood serum (if the involved light chain is 100 milligrams per liter or higher).

The M-protein the clonal plasma cells make is a defective protein because one part of it is missing. This test helps your doctor see how much of the defective protein is in your blood.

More than one bone lesion of at least 5 millimeters or bigger on an MRI.

The abnormal plasma cells in your bone marrow can cause damaged and weak spots in your bones. As a result, calcium from your bones is released into your bloodstream. Your body usually flushes extra calcium out in your pee. But when you have too much calcium flooding into your bloodstream too fast, your kidneys may have trouble filtering the extra calcium out.

High calcium levels will show up on basic blood tests, such as a comprehensive metabolic panel or basic metabolic panel. Anything over 10.5 milligrams per deciliter is considered hypercalcemia. If your levels are higher than 14 milligrams per deciliter, it's considered a medical emergency. If your levels are that high, your doctor will send you to the hospital so they can bring your calcium levels down safely.

Symptoms of high calcium levels include:

  • Feeling really thirsty
  • Peeing a lot
  • Dehydration
  • Weakness or fatigue
  • Bone pain
  • Headaches
  • Constipation
  • Belly pain
  • Loss of appetite
  • Feeling drowsy, confused, forgetful, or irritable
  • Muscle aches, weakness, cramping, or twitching
  • Coma, if your calcium level gets very high

The abnormal plasma cells in multiple myeloma can make so many M-proteins that it clogs up the filtration system in your kidneys. Over time, this can cause permanent damage.

You won't likely won't have symptoms early on, but your doctor can test for signs of kidney damage with a blood or urine test. If your kidneys aren't working well, you may have the following symptoms:

  • Weakness or fatigue
  • Nausea and vomiting
  • Confusion or trouble concentrating
  • Fluid buildup in your tissues, especially in your hands, ankles, or face
  • Peeing a lot
  • Cramps or muscle spasms
  • Dry or itchy skin
  • Poor appetite or metallic-tasting food

Your bone marrow makes all of your blood cells. If you have multiple myeloma, the clonal plasma cells can crowd out the cells that make your other blood cells in your bone marrow. In that case, your doctor can do a blood test to see if you have low levels of your other blood cells, including red blood cells, white blood cells, and platelets.

Anemia

Anemia is when you have low levels of red blood cells. Your red blood cells carry oxygen from your lungs to your tissues. If you have low levels of red blood cells, you may have any of the following:

  • Fatigue or weakness
  • Chest pain
  • Dizziness
  • Heart palpitations
  • Headache
  • Pale skin
  • Shortness of breath
  • Ringing in your ears, swooshing or whooshing noises in your ears in time with your heartbeats

Leukopenia

Leukopenia is the medical term for low levels of white blood cells. Specifically, it's low levels of a type of white blood cell called neutrophils. Neutrophils are like your immune system's first responders. They catch and kill invading bacteria, fungi, or viruses. If you have low levels of neutrophils, you may be more prone to infections, which can cause the following symptoms:

  • Fever and chills
  • Swelling and redness (inflammation)
  • Mouth sores
  • Red or white patches in your mouth
  • Sore throat
  • Severe cough or shortness of breath
  • Pain when you pee or bad-smelling pee
  • Unusual vaginal discharge or itching
  • Diarrhea
  • Cuts or sores that drain pus

Thrombocytopenia

Thrombocytopenia is when you have low platelet counts. Platelets are small blood cells that form blood clots to help you stop bleeding when you've been injured. If you have low platelet counts, you may have the following symptoms:

  • Bleeding gums
  • Blood in your poop, pee, or vomit
  • Rectal bleeding
  • Heavy menstrual periods
  • Easy bruising

Multiple myeloma cells can break down bone tissue, which can cause soft spots in your bones. These are called osteolytic lesions, and your doctor can see them on imaging tests, such as an X-ray and CT and PET/CT scans. Soft spots in your bones can lead to the following symptoms:

  • Bone pain, most commonly in your back, hips, or skull
  • Bone weakness, which could be all over (osteoporosis) or specifically where you have a tumor
  • Bone fractures, which can be from even a minor injury

Spinal compression

If myeloma softens the bones in your spine, they can collapse and press on your spinal cord. If this happens, you may have the following symptoms:

  • Sudden, severe back pain
  • Numbness or weakness, often in your legs
  • Muscle weakness, most commonly in your legs

If you have these symptoms, call 911 and get emergency medical help right away. If you don't get treatment immediately, you may have permanent nerve damage that could lead to paralysis.

Nerve damage

The M-proteins made by myeloma cells can cause damage to your nerve cells This can lead to a condition called peripheral neuropathy that causes a pins-and-needles feeling, often in your legs and feet.

Hyperviscosity

The M-proteins made by myeloma cells can also thicken your blood. This can slow blood flow to your brain and lead to:

  • Confusion
  • Dizziness
  • Symptoms of a stroke, like drooping on one side of your face, weakness or numbness in one arm, and slurred speech

If you have any of these symptoms, call 911 and get to the ER. You may need a procedure called plasmapheresis to help filter these extra M-proteins out of your blood.

There is no cure for myeloma. As it continues to advance, you will likely have more severe signs and symptoms. For instance, most people will have more bone pain and fatigue or tiredness. Some people may have serious infections, nerve damage, and kidney damage or failure.

At this point, your doctor may suggest you shift your treatment focus to palliative and supportive care options. The focus will be on easing your pain, reducing your symptoms, and improving your quality of life.

Multiple myeloma is cancer of the plasma cells in your bone marrow. Because the cancer cells grow out of control in your bone marrow, it swamps out other cells in your bone marrow that make other blood cells you need to function well. This can cause low blood cell counts, high blood calcium levels, kidney damage or failure, and bone and nerve damage. At first, multiple myeloma may not cause any symptoms, but eventually, you may have bone pain (often the first symptom), weakness or numbness in your limbs, fatigue, loss of appetite, raised thirst, easy bruising, and a fever. If you suspect you have multiple myeloma, talk to your doctor. There's no cure for multiple myeloma, but there is a possibility for remission if you get diagnosed and treated early.

What are the symptoms of smoldering multiple myeloma?

Smoldering multiple myeloma is a precursor to multiple myeloma. It means that you have some abnormal plasma cells, but it hasn't progressed to active multiple myeloma yet. And it may never progress to active multiple myeloma; about 10% of people diagnosed with smoldering multiple myeloma progress to active multiple myeloma each year for the first five years after diagnosis. After that, the chance of progression goes down.

Smoldering multiple myeloma doesn't generally cause any symptoms. Rather, it's usually first noticed on a blood test.

What other conditions can be mistaken for multiple myeloma?

Some conditions that may have similar symptoms to multiple myeloma include:

  • Primary lymphoma of bone
  • Metastatic bone disease
  • Monoclonal gammopathies of undetermined significance
  • Waldenstrom macroglobulinemia
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