Multiple Myeloma

Symptoms & Side Effects

The symptoms of multiple myeloma and side effects of its treatment vary from patient to patient. Some people with multiple myeloma may not have any symptoms, and it is rare for a person to experience all symptoms associated with the disease.

Some treatments are more likely to cause side effects than others. Knowing the symptoms and side effects to look for will help you and your doctor monitor your health. Tell your medical team as soon as any symptoms and side effects begin, even if you consider them trivial. If you feel better, you are more likely to complete your treatment as planned, and you’ll enjoy a better quality of life.

Anemia

Anemia is an abnormally low number of red blood cells in the blood. Red blood cells carry oxygen to the body’s tissues. Anemia can cause many symptoms, most often fatigue and weakness, and can be temporary or long lasting.

Prevention and management strategies:

  • Eat a good, balanced diet.
  • Ask your doctor if you have iron deficiency.

If you experience any of the following serious effects, contact your doctor immediately:

  • Dizziness
  • Shortness of breath or difficulty breathing
  • Rapid heartbeat, heart palpitations or chest pain

Bone Pain and Fractures

Because multiple myeloma begins in the plasma cells of the bone marrow, bone pain, serious injuries or osteoporosis (the thinning and weakening of bones) commonly occur. Pain management doctors are devoted to keeping you comfortable while also helping prevent bone damage. Bone health should be dealt with proactively, so address any pain as soon as you begin to feel it. Warning signs of bone loss include joint and back pain, arthritis-like symptoms, slouched posture, shorter stature and broken/fractured bones.

Prevention and management strategies:

  • If you don’t have hypercalcemia, focus on getting enough vitamin D and calcium. Ask your doctor about taking supplements and eating certain foods (such as yogurt or milk) that can boost your bone strength.
  • Find a pain management specialist, and ask about pain medications.
  • Ask about bisphosphonates, which are bone-strengthening medications.
  • Exercise to build muscle mass and protect fragile bones. Start with doctor-approved activities, such as walking or swimming.
  • If you have collapsed vertebrae, ask your doctor about a procedure to stabilize and support them.
  • Ask your doctor about radiation therapy.
  • Explore massage, meditation and acupuncture, which may relieve discomfort. Let your therapist know your condition and what medications you take.
  • Avoid alcohol and tobacco.
  • Take precautions to avoid falls and injuries. Keep your house well-lit inside and out, wear nonskid shoes and secure loose rugs.

Diarrhea

Certain types of treatment may affect your ability to have regular bowel movements. Mild diarrhea is an inconvenience. Left untreated, it can lead to serious problems, such as dehydration, loss of important nutrients, weight loss and fatigue.

Prevention and management strategies:

  • Drink plenty of fluids, including water and other clear liquids, such as broth.
  • Eat several small meals throughout the day rather than three big meals.
  • Eat bland, low-fiber foods, such as boiled white rice and boiled chicken.
  • Eat foods that have potassium, such as boiled or mashed potatoes and bananas.
  • Avoid alcohol, caffeine and fatty foods.
  • Talk with your doctor about using over-the-counter anti-diarrhea medications.

If you experience any of the following serious effects, contact your doctor immediately:

  • Six or more loose bowel movements per day for more than two days in a row
  • Blood in the stool, around the anal area, on the toilet paper or in the toilet bowl
  • Inability to urinate for at least 12 hours
  • Fever
  • Loss of five pounds or more after the diarrhea starts
  • Swollen or painful abdomen
  • Dizziness or light headedness upon standing up

Fatigue

The fatigue related to cancer and its treatments is different from the fatigue that healthy people feel. It usually lasts longer, is more severe and is unrelieved by sleep.

Prevention and management strategies:

  • Take frequent rest periods or naps, but limit each nap to 45 minutes. Get eight hours of sleep each night.
  • Participate in regular physical activity, such as walking, yoga or bike riding.
  • Prioritize. You can’t do it all, so choose your daily duties wisely and accomplish what you can.
  • Relax, take deep breaths, read a book, pray or meditate.
  • Ask your doctor about psychostimulant drugs that can counteract drowsiness caused by pain medication.
  • Set a routine for sleeping and waking.
  • Don’t ignore symptoms such as pain, nausea, vomiting or depression, which might be preventing you from sleeping.

Graft-Versus-Host Disease

Graft-versus-host disease (GvHD) is a common side effect of allogeneic stem cell transplantation. GvHD can occur when white blood cells from your donor (the graft) recognize healthy cells in your body (the host) as foreign and attack them. This problem can cause damage to your skin, liver, intestines and many other organs, and can occur a few weeks after the transplant or much later. Symptoms may range from very mild to life-threatening and can include skin rashes, yellowing skin or eyes (jaundice) and diarrhea. GvHD can be treated with steroids or other drugs that suppress your immune system.

If you experience any of the following serious effects, contact your doctor immediately:

  • Dryness of the eyes and mouth
  • Tightening, blistering or burning of the skin
  • Jaundice
  • Fever
  • Sudden weight loss
  • Abdominal pain or bloating

Hypercalcemia (High Levels of Calcium in the Blood)

Bone contains high levels of calcium. As bone becomes damaged and deteriorates, calcium is released into the blood. Hypercalcemia affects the entire body and can cause kidney, stomach and heart problems, and can result in a coma or even death. Talk to your doctor if you experience any of the warning signs, such as excessive thirst and/or urination, headaches, nausea/vomiting, constipation, confusion, depression or decreased appetite.

Prevention and management strategies:

  • Drink plenty of water to help prevent kidney stones and dehydration.
  • Exercise and stay active to encourage calcium levels to normalize.
  • Take necessary steps to manage nausea and vomiting.

If you experience any of the following serious effects, contact your doctor immediately:

  • Kidney stones
  • Heart problems
  • Loss of consciousness

Lowered Lung or Kidney Function

When the lungs and kidneys are not able to function at full capacity, they are at risk of being overworked and, ultimately, failing. Watch for symptoms of fatigue, shortness of breath, increase in thirst/urination, dehydration, constipation, loss of appetite or stomach pain.

Prevention and management strategies:

  • Visit your doctor for tests to make sure your organs are functioning as they should.
  • Drink plenty of water to flush your kidneys.

Nausea and Vomiting

These side effects can cause severe dehydration and interrupt your treatment plan. Talk to your doctor about lowering your medication doses or adding antiemetics (anti-nausea drugs).

Prevention and management strategies:

  • Eat five to six small meals instead of three large meals, and eat a light meal a few hours before receiving certain treatments.
  • Drink plenty of fluids throughout the day.
  • Identify and avoid foods, drinks or smells that trigger nausea.
  • Sip ginger ale or chamomile tea, or suck on peppermint candies.
  • Take deep breaths and try meditation to distract you from the discomfort.
  • Don’t lie flat after meals to avoid indigestion and upset stomach.
  • Avoid alcohol, spicy foods and caffeine.
  • Exercise after your meal has digested.

If you experience any of the following serious effects, contact your doctor immediately:

  • More than three episodes of vomiting per hour for at least three hours
  • Blood in vomit
  • Vomit resembling coffee grounds
  • Inability to drink more than eight cups of fluid or ice chips in 24 hours or eat solid food for more than two days
  • Weakness or dizziness
  • Cannot keep your medications down

Neutropenia (Low White Blood Cell Count)

Neutropenia is a low number of neutrophils, a type of white blood cell. Neutrophils play an important role in preventing infection throughout the body, so having an abnormally low number of neutrophils increases the risk of infection. Neutropenia also makes it more difficult for an infection to resolve if bacteria do enter the body. The lower the neutrophil count, the greater the risk for infection.

Prevention and management strategies:

  • Talk to your doctor about drugs that may help you produce more white blood cells.
  • Wash your hands often, and use hand sanitizer regularly.
  • Avoid sick people and crowded places.
  • Wear gloves when doing housework.

If you experience any of the following serious effects, contact your doctor immediately:

  • Fever (oral temperature over 100.5°F), OR chills OR sweating
  • Flu-like symptoms (body aches, chills, general fatigue) with or without fever
  • Coughing, shortness of breath or painful breathing
  • Abdominal pain
  • Sore throat or mouth sores
  • Redness, pain or swelling on skin
  • Pus or drainage from any open cut or sore
  • Pain or burning with urination
  • Pain or sores around the anus
  • Vaginal discharge/itching

Thrombocytopenia (Bleeding/Clotting Issues)

Some treatments for multiple myeloma can interfere with the body’s ability to make platelets, which are a type of blood cell. The result is a condition called thrombocytopenia, and it can lead to bleeding and clotting problems. People with multiple myeloma have a higher risk of developing blood clots, especially those who have a history of blood clots or are newly diagnosed.

Deep vein thrombosis (DVT) is a blood clot that occurs in a deep vein in the body, usually the legs or pelvis. DVT can be caused by physical inactivity, abnormal clotting or an injury to the blood vessels, but may also be a side effect of certain treatments. Initial symptoms may be minor, so it’s important to speak to your doctor immediately if you experience any discomfort in your legs.

Prevention and management strategies:

  • Get regular exercise.
  • Stay within a healthy weight limit.
  • If you smoke, quit.
  • Try to start moving after any extensive bed rest or after surgery (with your doctor’s permission).

If you experience any of the following serious effects, contact your doctor immediately:

  • An area on your body that is warm, painful, reddened, discolored or hardened
  • Swelling of one arm or leg
  • Difficulty breathing or chest pain
  • Rapid heartbeat

Potential Side Effects Related to Specific Multiple Myeloma Treatments

Treatment Type Potential Side Effect
Bisphosphonates
  • Fever
  • Flu-like symptoms
  • Nausea and vomiting
Chemotherapy
  • Diarrhea
  • Fatigue
  • Hair loss
  • Infertility
  • Low platelet count (thrombocytopenia)
  • Low red blood cell count (anemia)
  • Memory loss
  • Mouth sores
  • Nausea and vomiting
  • Nerve damage (neuropathy)
  • Shortness of breath
  • Weight loss
Corticosteroids
  • Acid reflux
  • High blood sugar level
  • Irritability due to restlessness
  • Low white blood cell count (neutropenia)
  • Mood swings
  • Problems sleeping
  • Puffy face and/or swollen feet
  • Weight gain
Immunotherapy
  • Back pain
  • Cough
  • Diarrhea
  • Fatigue
  • Fever
  • Infusion reaction
  • Low platelet count (thrombocytopenia)
  • Low red blood cell count (anemia)
  • Low white blood cell count (neutropenia)
  • Nausea
  • Peripheral neuropathy
  • Upper respiratory tract infection
Radiation therapy
  • Diarrhea
  • Fatigue
  • Loss of appetite
  • Low red blood cell count (anemia)
  • Low white blood cell count (neutropenia)
  • Nausea
  • Skin reactions
Stem cell transplantation
  • Damage to organs (liver, lungs and kidney)
  • Diarrhea
  • Inflammation of the lining of the digestive
  • tract and mouth (mucositis)
  • Low platelet count (thrombocytopenia)
  • Low white blood cell count (neutropenia)
  • Nausea and vomiting
Targeted therapy
  • Blood clots
  • Cough
  • Damage to organs (liver, lungs and kidney)
  • Diarrhea, constipation
  • Fatigue or drowsiness
  • Flu-like symptoms (fever/weakness)
  • Headache
  • Heart complications
  • Hypertension
  • Hypothyroidism
  • Itching/rash
  • Loss of appetite
  • Low red blood cell count (anemia)
  • Low white blood cell count (neutropenia)
  • Mouth sores
  • Nausea
  • Nerve damage (neuropathy)
  • Shortness of breath
  • Swelling in arms/legs

 

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