Myeloma Action Month: Recognising The Warning Signs Of Multiple Myeloma

Persistent bone pain with no clear reason; repeated infections which are slower than normal to get better; and a typical blood test showing unexpected results. Seen separately, these do not seem connected. But, together, they are what haematology specialists recognise as needing prompt, additional testing. 

Multiple myeloma is a cancer affecting plasma cells – the cells in bone marrow which make antibodies. It makes up roughly ten per cent of all blood cancers, and usually affects adults past sixty, although younger people can also be affected. Identifying the first indications of it makes the time between the start of symptoms and useful treatment shorter. 

What Happens Inside the Bone Marrow 

Plasma cells usually create immunoglobulins; the antibodies which are key to immune defence. In multiple myeloma, an abnormal group of plasma cells grows out of control inside the marrow, preventing the creation of healthy blood cells. These abnormal cells also make one type of antibody which does not work, called a paraprotein, or M-protein – and this can be found in the blood or urine.  

This crowding stops the production of red blood cells, white blood cells and platelets all at once. Involvement of the bone marrow also sends signals which activate osteoclasts – the cells breaking down bone – while stopping the cells which rebuild it. This imbalance makes the bone problems that are among the most obvious parts of the disease. 

Multiple Myeloma Symptoms and Their Origins 

Bone pain is the most often first symptom. It usually affects the back, ribs, hips and skull – the places where active red marrow is most plentiful. The pain is frequently deep, aching, and gets worse with moving or bearing weight. Fractures of the spine from bone weakening linked to myeloma can happen with very little, or no, previous injury. 

Multiple myeloma symptoms linked to anaemia include tiredness, difficulty breathing when active, paleness and reduced ability to exercise. These happen because myeloma cells crowd out the cells in the marrow which will become red blood cells, steadily reducing the amount of haemoglobin made. A lot of patients first go to their family doctors because of these anaemia symptoms, before myeloma is even thought of. 

The Warning Signs That Often Precede Diagnosis 

Frequent infections – particularly bacterial pneumonias and urine infections – show the immunoparesis which develops as normal immunoglobulin production is reduced. The body continues to make protein, but the paraprotein made by myeloma cells has no protective effect. So, good immunity is lowered, even though antibody production looks active. 

The warning signs of myeloma which involve kidney function need special attention. Myeloma-related kidney damage happens because the paraprotein and light chains made by myeloma cells go into the urine and harm tubular cells. High creatinine, protein in the urine, and reduced urine production can all show kidney involvement – and this is present in a large number of patients when they are diagnosed. 

Hypercalcaemia and Its Neurological Effects 

High blood calcium is another clear problem. As bone breaks down under myeloma’s effect, calcium is released into the blood in too much quantity. High blood calcium causes sickness, constipation, confusion, extreme thirst and increased passing of urine. These symptoms are often thought to be dehydration, a stomach illness, or changes in thinking linked to age. 

Recognising high blood calcium as possibly myeloma-related needs a degree of clinical doubt, especially in older patients showing this group of symptoms. A calcium level in the blood, along with a full blood count and protein electrophoresis, gives the first essential layer of testing when myeloma is one of the possible diagnoses.  

How Multiple Myeloma Diagnosis Is Confirmed 

Diagnosis is based on a combination of results. Serum protein electrophoresis identifies and measures the paraprotein. A twenty-four hour urine sample finds Bence Jones proteins – the light chain pieces made by myeloma cells. Bone marrow biopsy confirms the percentage of plasma cells, and gives material for genetic analysis, which helps decide the risk level and treatment choice. 

Whole-body low-dose CT or PET-CT imaging maps skeletal involvement, identifying areas of bone loss invisible on normal X-ray until they are a large size. The haematology specialists combine these tests with molecular profiling to set the stage of the disease and plan treatment accurately from the point of confirmed diagnosis.  

Multiple Myeloma Diagnosis: The Distinction Between MGUS and Active Disease 

Not every paraprotein finding is active myeloma. Monoclonal gammopathy of undetermined significance – known as MGUS – is a state before the disease, where a small paraprotein can be found, but the plasma cell percentage stays low and there is no damage to organs. MGUS moves to active myeloma at a rate of about one per cent a year. 

Multiple myeloma diagnosis involves telling the difference between MGUS, smouldering myeloma, and active myeloma which needs treatment. Smouldering myeloma meets higher paraprotein levels and plasma cell percentages, but still has no organ damage. How often surveillance is done and what treatment levels are, are different across these states – so accurate classification is the basis of right management. 

Treatment Advances in Recent Years 

Proteasome inhibitors, immunomodulatory agents, and anti-CD38 monoclonal antibodies now form the core of treatment for newly diagnosed and returning disease. Combined treatments using agents from several classes produce deeper and more lasting responses than earlier single-agent or two-agent treatments. Response is measured by the fall in paraprotein and plasma cell percentage in the bone marrow.  

Autologous stem cell transplant remains a way of strengthening for patients who are able to have it after first treatment, extending how long the response lasts in people carefully chosen. Whether someone is able to have this is judged by age, organ function, other illnesses, and response to starting treatment – not by using a set age limit. 

Living With Myeloma as a Chronic Condition 

Myeloma is not usually curable in most patients, but is a controllable long-term condition for a lot of people. Times without treatment are possible, and quality of life during remission can be really good with the right supportive care. Checking during remission involves regular paraprotein testing and clinical review to find early signs of return before symptoms show. 

Bone health management – including bisphosphonate treatment to lower fracture risk and bone events – is always part of the long-term care plan. Vaccination and infection checking remain important all the time, given the continuing weakness of the immune system which shows in the warning signs of myeloma, and the condition itself, long after the first treatment is finished.