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.
This section discusses how to manage these symptoms. Your health care team 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 side effects experienced by people with myeloma. The myeloma cells release chemicals that damage the cells that normally repair damaged bone. When this happens, bone breaks down faster than it can be repaired, causing bone pain, bone damage (lytic 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!
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 or palliative care specialists will help keep your pain under control. It’s better to take pain medicine regularly, 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.
Tips for managing pain
- Complementary therapies, such as relaxation and meditation, sometimes work well when used along with pain medicine.
- Talk to a psychologist about cognitive behaviour therapy (CBT). This approach aims to change how you feel pain by changing your thoughts.
- Listen to our relaxation and meditation audio tracks and our podcast on Managing Cancer Pain, and see Pain and cancer.
- Download Myeloma Australia’s Pain and Myeloma information sheet
- Tell your treatment team if you are experiencing pain – don’t wait for them to ask.
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. Often, the damage is temporary and the kidneys can recover. In some people, the kidney problems are permanent and require dialysis. This is a way of filtering the blood using a machine.
Tips for managing kidney damage
People with myeloma should drink three litres of fluids a day. This can include water, tea, coffee, fruit juice and milk.
Ask your doctor if it’s necessary to avoid using painkillers that contain a non-steroidal anti-inflammatory drug (NSAID), because these can also damage the kidneys.
It is also important to treat any infections quickly to limit further stress on the kidneys. Also ask your doctor if you should avoid contrast dye during CT or MRI scans.
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 anaemia is causing you significant symptoms, 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
Many of the active drug therapies, such as high-dose steroids and treatments such as pomalidomide, lenalidomide, bortezomib, carfilzomib and chemotherapy, can also weaken your immune system. This makes you more likely to get infections and less able to fight any infections that do occur. Learn ways to reduce your risk of infection and when you need to contact your doctor urgently.
If your white blood cell count falls very low, it’s important to treat infections with appropriate antibiotics immediately. You may also be given a course of the special growth factor drug G-CSF and if you have repeated infections, you may be given intravenous immunoglobulins (antibodies).
Taking care with infections
Reduce your risk |
When to seek medical help |
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To prevent the spread of infection:
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Contact your doctor or go to the nearest hospital emergency department immediately if you experience one or more of the following symptoms:
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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.
Tips for managing fatigue
- Try to keep as active as possible. See Exercise and cancer for helpful tips and exercise videos.
- Plan activities for the time of day when you tend to feel most energetic.
- If you’re having trouble sleeping, try some relaxation and meditation exercises. Call Cancer Council 13 11 20 for resources that may help.
- Fatigue is a common side effect of cancer treatment, but it can also be a symptom of depression.
- Download Myeloma Australia’s information sheet on fatigue.
- Listen to our podcast on Managing Cancer Fatigue.
Nerve and muscle effects
Many people with myeloma develop tingling (“pins and needles”), pain or numbness 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.
Tips for managing peripheral neuropathy
- Take care when moving around as you are more likely to fall if your feet are numb or your legs are weak.
- Keep your hands and feet warm to help the blood circulate. Gloves and warm socks can help when it’s cold or soak your hands and feet in warm water.
- Wear properly fitting shoes – tight shoes can make the tingling worse, while loose shoes may make you stumble.
- If your symptoms are severe, talk to your doctor about whether you can take any medicines that offer relief.
- For more on this, see Peripheral neuropathy and cancer, or download Myeloma Australia’s booklet on Managing Peripheral Neuropathy.
Additional resources
Prof John Gibson, Haematologist, Institute of Haematology, Royal Prince Alfred Hospital and The University of Sydney, NSW; Dr Stephanie Anderson, Registrar, Institute of Haematology, Royal Prince Alfred Hospital, NSW; Tanya Carney, Consumer; Jacqui Keogh, NSW State Manager/Senior Myeloma Nurse NSW, Myeloma Australia; Dr Silvia Ling, Haematologist, Liverpool Hospital, NSW; Rachel McCann, Myeloma Support Nurse NSW, Myeloma Australia; John McMath, Consumer; Karen Robinson, 13 11 20 Consultant, Cancer Council NSW.
View the Cancer Council NSW editorial policy.
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