Multiple myeloma history and symptoms

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Hannan Javed, M.D.[2]; Haytham Allaham, M.D. [3]; Shyam Patel [4]

The history and symptoms of multiple myeloma are based on the underlying effect of excess plasma cells on various organ systems. Pain is usually a symptom of newly diagnosed multiple myeloma. Broad categories of symptoms include bone-related symptoms, neurological symptoms, hypercalcemia-related symptoms, bone marrow failure-related symptoms, and thrombosis-related symptoms. Although all of these symptoms are possible, the presentation of multiple myeloma varies from patient to patient.

Relevant history includes:

• Review of past medical history for other plasma cell diseases, hematologic malignancies, underlying renal disease, and underlying bone disease
• Review of family history for members with positive history of hematologic malignancies
• Review of occupational history related to farming, oil industry, or Agent Orange exposure

History includes character, location, onset, and duration of pain (typically bony pain). Symptoms of multiple myeloma include:^{[1][2][3][4][5][6]}

• Bone pain

• Usually involves the spine and ribs (axial skeleton), and worsens with activity
• Persistent localized pain may indicate a pathological bone fracture
• Inability to carry out routine tasks due to limitation by pain

• Neurological symptoms

• Numbness due to plasma cell infiltration of nerves or anti-neuronal glycoprotein antibodies
• Muscle weakness
• Confusion
• Dizziness
• Headache
• Paralysis
• Visual changes

• Hypercalcemia-related symptoms

• Polyuria
• Polydipsia
• Constipation
• Loss of appetite
• Nausea and vomiting
• Lethargy due to anemia

• Bone marrow failure-related symptoms: This is due to crowding out of normal bone marrow precursors by malignant plasma cells.

• Easy bruising, nosebleeds, bleeding gums due to thrombocytopenia
• Fatigue, weakness, shortness of breath, dizziness and paleness due to anemia
• Recurrent infections due to leukopenia

• Lower limb edema due to renal involvement

• Thrombotic symptoms: Thrombosis is more common in multiple myeloma due to cancer-associated thrombosis and due to lenalidomide, which increases thrombotic risk.

• Shortness of breath due to pulmonary embolism
• Lower extremity edema due to deep vein thrombosis
• Abdominal pain due to mesenteric venous thrombosis
• Transient ischemic attack
• Retinal hemorrhage