Managing symptoms of myeloma

Myeloma and its different treatments may cause symptoms and side effects.

Most of these issues are caused by the build-up of myeloma cells in the bone marrow and the presence of paraprotein in the blood or urine.

Here we discuss how to manage these symptoms. Your cancer specialists may refer to these as supportive treatments.

Learn more about:

• Bone disease
• Pain
• Kidney damage
• High calcium in the blood
• Thicker blood
• Anaemia
• Infections
• Fatigue
• Nerve and muscle effects

Bone disease

Bone disease is one of the most common complications experienced by people with myeloma.

The myeloma cells release chemicals that damage the cells that normally repair damaged bone. When this happens, the bone breaks down faster than it can be repaired, causing bone pain, bone lesions or even fractures. The middle or lower back, the rib cage and the hips are the most frequently affected areas.

The rapid breakdown of bone can lead to an increase in blood calcium levels (hypercalcaemia).

A group of drugs called bisphosphonates are used to treat bone disease. They help to control hypercalcaemia, manage existing bone disease and slow down any further bone destruction.

Increasingly, those of us with myeloma are living longer and with a better quality of life – so much so that research is now needing to be done on longer-term effects of the cancer and its treatments. This is almost a nice ‘problem’ to have!

– Read more of Brigita’s story

Pain

Pain is the most common symptom at diagnosis for people with myeloma. It is often related to bone damage that has been caused by the disease.

Regular reviews by pain management specialists will help keep your pain under control. It’s better to take pain medicine regularly as prescribed, rather than waiting until you feel pain.

Some people may need further treatment to manage pain. This may include localised radiation therapy or, in some specific cases, vertebroplasty. This involves injecting medical-grade cement into the spine because it has collapsed.

Kidney damage

Kidney problems can develop in people with myeloma for various reasons.

The paraprotein produced by myeloma cells can damage the kidneys. This is particularly common with the Bence Jones protein. Other complications of myeloma, such as dehydration, infection and hypercalcaemia, can also damage the kidneys, as can some of the drugs used to treat myeloma and its symptoms.

The treatment for kidney damage in people with myeloma will depend on the cause. In many cases, the damage is temporary and the kidneys can recover. In a small number of people, the kidney problems are permanent and require dialysis. This is a way of filtering the blood using a machine.

High calcium levels in the blood

The myeloma cells in the bones can sometimes start to break down some of the bone cells, which releases calcium into the blood. This condition is called hypercalcaemia.

It can cause symptoms such as tiredness, nausea, constipation, bone pain, thirst, irritability and confusion.

In some people, hypercalcaemia is discovered during a blood test before any symptoms develop.

People with hypercalcaemia need to drink extra fluids. However, they might also require treatment in hospital, which may include intravenous fluids, steroids and bisphosphonates. Treatment of the myeloma itself will often help to control the high calcium levels in the blood.

Thicker blood

Occasionally, the myeloma cells release so much paraprotein into the blood that the blood becomes thick and starts to circulate more slowly. This is known as hyperviscosity syndrome.

The thickened blood may block small blood vessels in the brain, and this can lead to blurred vision, confusion, headaches and dizziness. It can also cause stroke-like symptoms such as slurred speech and weakness on one side of the body. A process called plasma exchange can quickly remove the excess paraprotein from the blood and improve symptoms.

Anaemia

Anaemia means you have a low red blood cell count. You may look pale, feel weak and tired, and be breathless.

It is common to have anaemia when myeloma is diagnosed, but this will normally get better when treatment begins to control the myeloma.

Sometimes anaemia develops because of the treatment itself. If this happens, your doctor may suggest a blood transfusion to increase your red blood cell count. The blood will be given to you through a catheter inserted into a vein in your arm.

Infections

Myeloma, high-dose steroids and treatments such as bortezomib, lenalidomide, thalidomide and chemotherapy can weaken your immune system. This makes you more likely to get infections and less able to fight any infections that do occur.

If your white blood cell count falls very low, antibiotics may help prevent infections, while drugs called growth factors can stimulate the production of white blood cells. If you have repeated infections, you may be given intravenous immunoglobulins (antibodies).

Fatigue

Feeling very tired and lacking the energy to do day-to-day things is known as fatigue. It is different from normal tiredness because it often doesn’t go away with rest or sleep.

Fatigue is very common in people with myeloma and may last for weeks or months after treatment ends. It can be caused by the cancer itself, or by the physical and emotional side effects of diagnosis and treatment.

Sometimes people don’t tell their doctor about fatigue because they think nothing can be done about it. However, your treatment team may be able to suggest strategies to manage the fatigue.

Nerve and muscle effects

Many people with myeloma develop tingling (“pins and needles”), pain or loss of sensation in the  fingers and/or toes, and muscle weakness in the legs. This is called peripheral neuropathy because it involves the nerves of the peripheral nervous system.

Peripheral neuropathy may be caused by the myeloma itself. The paraprotein produced by myeloma cells can travel through the bloodstream, build up in nerve tissue, and damage the nerve cells.

Some myeloma treatments, such as thalidomide and bortezomib, can also damage the nerve cells.

Always tell your doctor if you have tingling or numbness, as your treatment may need to be adjusted.