Myeloma can lead to other mild to serious health complications and side effects:
One of the most troublesome complaints reported by myeloma patients is fatigue. Fatigue can be caused by many factors, including disease-related anemia, treatment and medication side effects, physical immobility, sleep disturbance, nutritional deficits, depression, stress and anxiety. Each individual’s fatigue should be evaluated to identify other possible causes that are unrelated to myeloma, and management strategies that can be implemented to alleviate fatigue-causing or fatigue-related issues.
A helpful strategy to keep a consistent energy level while dealing with fatigue may be to pace daily activities and take planned rest periods throughout the day. Support, compassion and understanding of self and from loved ones are key elements in managing fatigue successfully.
Your infection risk increases when myeloma prevents your white cells from making antibodies to fight infection and keep your immune system working properly. Add chemotherapy, which is toxic to both normal blood cells as well as myeloma cells, and normal cells are eliminated from the bone marrow. Follow your doctor's instructions for avoiding infections. He or she may sometimes prescribe antibiotics as a preventive measure. You may also receive regular gamma globulin preparations, but this is less common because of their serious health risks.
Bone pain may occur because of the growth of myeloma cells in the bone. Successful treatment may relieve bone pain. Patients may also experience pain that radiates from the back when the back bones (vertebrae) collapse and press on the nerves. Fractures of bones may also result in pain. In addition to treatment of the myeloma, many patients require pain medications, such as acetaminophen (Tylenol®) and, in some cases, narcotics. Narcotics can cause some sedation and constipation, but are often very effective and are not associated with a high risk of addiction or dependency in cancer patients. For more information see Pain Management Facts.
High levels of Bence Jones protein in the urine can interfere with healthy kidney function as can excess calcium in the blood (called hypercalcemia) and uric acid in the urine (hyperuricemia). Both are conditions common to myeloma. Your doctor will regularly monitor your kidney function. In rare cases, you may experience kidney (renal) failure. You doctor may use a procedure called plasmapheresis and exchange to limit kidney damage, although there's some controversy among doctors about whether this procedure is effective. Dialysis may sometimes be needed as well. However, successful myeloma treatment often improves or restores healthy kidney function.
Occasionally, the concentration of monoclonal proteins in the blood of some myeloma patients is so high that it makes the blood “viscous” or thick, thereby interfering with the blood flow and delivery of oxygen to the tissues. The heart has to work harder to pump blood. This complication can lead to headaches, dizziness, weakness, fatigue, sleepiness, oozing from cuts and other symptoms. This condition is considered a medical emergency, and it needs urgent treatment with plasmapheresis and exchange, which rapidly reduces the concentration of monoclonal proteins in the blood. Chemotherapy is also needed to kill the cells that produce M protein and prevent hyperviscosity syndrome from recurring.
Rarely, monoclonal IgM may congeal in the blood and lead to poor circulation, especially if the body is exposed to cold temperatures. This condition can cause joint pain, kidney problems, skin lesions and purpura (purplish or red-brown skin discoloration). Cryoglobulinemia is a rare condition.
Acute Myeloid Leukemia
Myeloma patients have an increased risk of developing acute myeloid leukemia (AML), especially after being treated with cytotoxic anticancer drugs. AML development, however, is a rare occurrence.
Osteonecrosis of the Jaw
Patients who take bisphosphonates such as pamidronate (Aredia®) and zoledronic acid (Zometa®) may be susceptible to a type of jawbone damage called osteonecrosis of the jaw (ONJ). ONJ is rare. It occurs when bones in the jaw begin to break down and die. Before you begin any treatment with bisphosphonates, get any needed dental work completed and a dental exam. Your oncologist should coordinate closely with an oral surgeon or dental specialist to manage your bisphosphonate treatment. ONJ treatment may include antibiotics, oral rinses and removable mouth prostheses. Occasionally, minor surgery is needed to remove injured tissue and reduce sharp bone edges.
The bone marrow is constantly producing red cells, white cells and platelets. Interruption or inhibition of this crucial function is called "myelosuppression." Chemotherapy agents and immunomodulatory drugs, including Velcade® and Revlimid®, can cause myelosuppression. If not managed effectively, myelosuppression can be life-threatening and interfere with treatment planning and quality of life. A reduction in red cells can result in anemia, which can make patients feel extremely tired and experience shortness of breath. When the number of neutrophils, the primary type of white cells, is lowered, the resulting condition is called "neutropenia," which can lead to serious infections that require patients to receive antibiotic therapy and possibly be hospitalized. Drugs such as filgrastim (Neupogen®), pegfilgrastim (Neulasta®) or sargramostim (Leukine®) may be prescribed to treat neutropenia. When myelosuppression causes the depletion of platelets in the blood, the resulting condition is called "thrombocytopenia." With low platelet counts, patients may experience excessive bleeding from cuts or injuries and may need a platelet transfusion.
Temporary or ongoing numbness, tingling, burning, coldness or weakness in the arms or legs are symptoms of peripheral neuropathy, which occurs when the nerves to your peripheral nervous system are damaged.
It can be a result of the disease, or it can be a side effect of certain anticancer drugs, including vincristine (Oncovin®), bortezomib (Velcade®), carfilzomib (Kyprolis®), thalidomide (Thalomid®), pomalidomide (Pomalyst®), and, less commonly, lenalidomide (Revlimid®). Let your doctor know immediately if you experience any symptoms common to peripheral neuropathy. He or she can adjust your medication to relieve the condition.
Thrombosis and Embolism
Deep venous thrombosis (DVT) occurs when a blot clot develops in a vein deep in your body, usually in the legs. DVT can cause pain and swelling in the affected limb. If the clot breaks away, it can travel to your lungs or pulmonary arteries and become a pulmonary (lung) embolism, which can be life threatening.
Myeloma patients risk developing DVT and pulmonary embolism as a result of treatment with drugs such as thalidomide (Thalomid) and lenalidomide (Revlimid) combined with corticosteroids like dexamethasone (Decadron®) and liposomal doxorubicin (Doxil®). Some doctors have observed that taking either Thalomid or Revlimid and dexamethasone in combination with red cell growth factors, for example epoetin alfa (Procrit®) or darbepoetin alfa (Aranesp®), further increases a patient’s risk for DVT. Other factors that can increase the risk of DVT include the presence of a central line (central venous catheter), decreased mobility, recent surgery, pregnancy, smoking, a prior history of DVT or a family history of blood-clotting problems.
Patients receiving myeloma treatment associated with DVT risk, especially newly diagnosed myeloma patients, are usually prescribed medication (such as aspirin, warfarin (Coumadin®), or low-molecular-weight heparin) to reduce the risk of DVT. It is important for patients to discuss with their doctors the risk of DVT and ask which of the options to reduce this risk is best for them.