Multiple Myeloma: Symptoms, Causes, and Risk Factors

Multiple myeloma is a type of blood cancer that affects plasma cells, a kind of white blood cell found in bone marrow. This cancer disrupts the body’s immune system, impairs blood formation, and can lead to serious complications throughout the body. Understanding multiple myeloma’s symptoms, underlying causes, and the risk factors is crucial for early detection and effective management.

What is Multiple Myeloma?

Multiple myeloma is a cancer that begins in plasma cells, which are essential to immune function. Normally, plasma cells help combat infections by creating antibodies. In multiple myeloma, these cells become abnormal, multiply uncontrollably, and begin to crowd out healthy cells in the bone marrow.

The accumulation of these malignant plasma cells can cause a range of problems:

• Crowding out of healthy blood cells, leading to anemia and increased risk of infections
• Overproduction of abnormal proteins, which can harm the kidneys and other organs
• Damage and weakening of bones, increasing the risk of fractures

Symptoms

In its initial stages, multiple myeloma may not cause any noticeable symptoms. As the disease progresses, symptoms may arise and vary in type and severity from person to person. The following are common symptoms and complications associated with multiple myeloma:

• Bone pain (frequently in the back, chest, or hips)
• Fatigue and persistent tiredness
• Anemia (low red blood cell count)
• Frequent infections
• Nausea
• Constipation
• Loss of appetite
• Unexplained weight loss
• Mental confusion or “mental fogginess”
• Weakness
• Increased thirst and dehydration
• Increased urination
• Bruising or bleeding easily (due to low platelet count)

Bone pain is a particularly important indicator, often affecting the spine or ribs. Some patients may present with symptoms related to kidney problems or hypercalcemia (high blood calcium levels), which can manifest as nausea, confusion, constipation, and excessive thirst.

Common Complications

• Bone fractures due to weakened bones
• Kidney dysfunction or failure due to protein buildup
• Hypercalcemia leading to neurological and gastrointestinal symptoms
• Immune suppression, increasing infection risk

Table: Common Symptoms and Their Possible Causes

When to See a Doctor

If you notice any persistent symptoms—particularly bone pain, fatigue, unexplained weight changes, or increased susceptibility to infections—schedule a medical evaluation. Although these symptoms can be associated with many less serious conditions, early diagnosis improves management and outcomes in multiple myeloma.

Causes of Multiple Myeloma

The precise cause of multiple myeloma remains unknown. The disease most commonly begins with a single abnormal plasma cell in the bone marrow. This cell undergoes a genetic change that triggers unregulated growth and prevents normal cell death, resulting in the accumulation of malignant plasma cells.

Cancer Development in Myeloma

• Healthy plasma cells are generated and destroyed at controlled rates.
• In myeloma, damaged DNA leads to the continuous division and survival of malignant plasma cells.
• These cells produce abnormal antibodies, known as monoclonal (M) proteins, which do not help protect against infections and can harm organs.
• Cancerous plasma cells also prevent the production of adequate numbers of healthy cell types (red cells, white cells, platelets), causing widespread physiological disruption.

The Developmental Stages: MGUS and Smoldering Multiple Myeloma

Monoclonal Gammopathy of Undetermined Significance (MGUS)

Multiple myeloma nearly always begins as MGUS, a premalignant condition. In MGUS, abnormal plasma cells create low levels of M proteins in the blood, but without symptoms or organ damage. Only a minority of those with MGUS will ever progress to multiple myeloma.

• MGUS is generally benign and is often discovered during routine blood tests.
• Only a small percentage (about 1% per year) of people diagnosed with MGUS develop multiple myeloma.

Smoldering Multiple Myeloma (SMM)

If MGUS advances, it can evolve into smoldering multiple myeloma (SMM). SMM consists of higher quantities of abnormal plasma cells or M protein but still does not cause symptoms or organ damage. This intermediate phase has an increased risk of progressing to symptomatic, active myeloma.

• SMM may exhibit many underlying features of cancer based on genetic analysis.
• Progression rates from SMM to active myeloma are higher than with MGUS.
• Patients with SMM require close monitoring but usually do not need immediate treatment unless signs of progression emerge.

Risk Factors

The likelihood of developing multiple myeloma increases with certain risk factors, although the disease can occur in people with no significant risk profile:

• Age: Most cases occur in people over age 60; it rarely affects those under 45.
• Sex: Men are slightly more likely than women to develop the disease.
• Race: African Americans have roughly double the risk compared to people of European descent.
• Family History: A close relative with multiple myeloma or MGUS slightly increases risk.
• Personal History: Prior diagnosis of MGUS or SMM significantly increases the likelihood of developing myeloma.

Other factors, such as obesity and workplace exposure to certain chemicals (like pesticides or petroleum products), may also contribute, but their roles are less clearly defined.

How Multiple Myeloma Harms the Body

The abnormal plasma cells in myeloma affect organs and tissues in several ways:

• Bone Marrow Suppression: Cancerous cells crowd out normal cells, leaving fewer healthy red cells (causing anemia), white cells (raising infection risk), and platelets (leading to bruising or bleeding).
• Bone Damage: Myeloma cells stimulate the breakdown of bones, leading to pain, fractures, and increased blood calcium levels.
• Kidney Injury: The excess M protein clogs the kidneys, impairing their filtering function and potentially causing failure.
• Immune Dysfunction: Although myeloma cells produce large amounts of antibody, these are abnormal and ineffective, leaving the patient vulnerable to infections.
• Hypercalcemia: As bones dissolve, calcium is released into the bloodstream, causing neurological symptoms and dehydration.

Prevention and Early Detection

There is currently no known way to prevent multiple myeloma, as most causes remain unknown. However, early detection through blood tests and awareness of risk factors can improve outcomes. Adults—especially if they have a family history of blood disorders or are in a high-risk group—should report unexplained symptoms for prompt evaluation.

Frequently Asked Questions (FAQs)

What are the very first signs of multiple myeloma?

Early on, many people with multiple myeloma experience no symptoms. When symptoms do appear, the first may include persistent bone pain (often back or ribs), fatigue, or frequent infections.

Is multiple myeloma hereditary?

Multiple myeloma is not directly inherited, but having a close relative with this disease or MGUS can increase risk to some degree.

What is the difference between MGUS, smoldering myeloma, and multiple myeloma?

MGUS is a harmless condition with low levels of abnormal protein. Smoldering multiple myeloma shows higher abnormalities but still no symptoms. Active multiple myeloma is symptomatic and causes organ damage or blood problems.

How does multiple myeloma affect the bones?

Myeloma cells trigger bone breakdown and interfere with bone renewal, leading to weak spots, fractures, and high calcium levels in the blood.

When should I see a doctor about possible myeloma?

Consult a healthcare provider if you notice persistent bone pain, fatigue, recurrent infections, changes in urination, or unexplained weight loss—especially if you have additional risk factors.

Key Takeaways

• Multiple myeloma is a cancer of plasma cells that causes widespread effects on bones, kidneys, blood, and the immune system.
• Early stages may have no symptoms, but bone pain, fatigue, anemia, and frequent infections signal disease progression.
• The disease arises from a transformation in plasma cells, evolving from MGUS through smoldering phases before becoming symptomatic.
• Risk increases with age, male sex, African ancestry, family history, and certain pre-existing blood plasma cell disorders.
• Early recognition and intervention can improve quality of life and survival outcomes.

Learn More About Multiple Myeloma

• Diagnosis and treatment: Early and accurate diagnosis is essential. Medical advances continue to improve life expectancy and quality of life for patients living with myeloma.
• Living well: Comprehensive and multidisciplinary care, regular monitoring, and appropriate management of complications greatly support patient outcomes.

For more information, support, or to connect with clinical research, visit reputable sources or consult specialized healthcare professionals.

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medha deb

 

Medha Deb is an editor with a master's degree in Applied Linguistics from the University of Hyderabad. She believes that her qualification has helped her develop a deep understanding of language and its application in various contexts.

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