Treating and preventing problems caused by myeloma

Myeloma and its treatment can affect you in different ways. It can cause symptoms and problems. Supportive treatments can help to either prevent or control these problems.

The problems or symptoms you have depend on how the myeloma is affecting your body. And it also depends what treatment you have. Tell your doctor or nurse about any symptoms that you have so they can help you.

You might have supportive treatments to prevent or help control the following problems:

  • infection
  • low red blood cells
  • bone problems including pain and spine fractures
  • kidney problems
  • nerve problems
  • symptoms caused by thickened blood (hyperviscosity)
  • tiredness (fatigue)

Tell your doctor or nurse about any symptoms that you have so they can help you.

Treating and preventing infection

Myeloma and its treatment affect your immune system. So you are more at risk of getting infections.

Treating infections

Signs of infection can include:

  • a change in temperature
  • aching muscles
  • headaches
  • feeling cold and shivery and generally unwell

You might have other symptoms depending on where the infection is.

It’s important to tell your hospital treatment team urgently if you have any signs of infection.

For some infections you can have treatment at home. But other infections can be life threatening, and you will need treatment in hospital. This is so that you can have the antibiotics into your bloodstream through a drip.

Preventing infection

Your doctors might recommend that you have vaccinations to protect against flu and chest infections. Your doctor or specialist nurse can advise you about this.

Treatment for low red blood cells (anaemia)

Anaemia means that you have a low red blood cell count. Red blood cells carry oxygen around the body. Your body cells don't have a good supply of oxygen if the level of red blood cells is low. So you feel tired (fatigued) and might also feel breathless. Your doctor will check your full blood count. 

Anaemia is quite common in people with myeloma. Your bone marrow might not make enough red blood cells because of the myeloma or treatment.

Anaemia is also common if your kidneys are not working very well. Healthy kidneys make a hormone called erythropoietin (EPO). This helps the bone marrow to make red blood cells.

Blood transfusion

You can have a blood transfusion if you are anaemic. This can help you to feel better.

Erythropoietin injection

You might have treatment with erythropoietin if:

  • your kidneys are not working properly
  • you have severe anaemia that keeps coming back despite blood transfusions

You have erythropoietin as an injection under the skin, usually in the leg or in the tummy (abdomen).

Treating and preventing bone problems

It is common for people with myeloma to have bone problems and bone pain. Myeloma weakens the bones which can lead to breaks (fractures).

Controlling pain

Most people with myeloma have some pain because of bone damage. Having pain has a big impact on how your feel in yourself and interferes with your daily life. It is important to talk to your healthcare team if you have pain so they can help you manage it.

There are different painkillers (analgesics) that might help. If one doesn't work, tell the team looking after you. They can prescribe something else. People with myeloma need to avoid non steroidal anti inflammatory drugs because they can cause kidney damage. 

Bisphosphonate drugs Open a glossary item can help to reduce bone damage. They slow down the damage caused by myeloma cells. There are different types of bisphosphonates, but the most common are pomidronate and zolendronic acid (zometa). You usually have these as a drip into the vein (intravenously) every 4 weeks. 

You might also take calcium and vitamin D supplements if you are having bisphosphonates. Your doctor will tell you about this.

Radiotherapy to an area of myeloma might reduce pain. There may be a limit to the amount of radiotherapy you can have to any part of your body. So if you have pain in an area where you have had radiotherapy, you might not be able to have this treatment again. 

Spinal bone fractures (breaks)

Some people with myeloma have breaks (fractures) of the spinal bones (vertebrae). This can put pressure on the spine and be very painful. The vertebrae can collapse, making the spine change shape. Your spine can become very curved. Doctors call this kyphosis. You might lose some height because of this.

Your doctor might offer a treatment such as:

  • vertebroplasty
  • balloon kyphoplasty
  • surgery
  • radiotherapy

 During a vertebroplasty your doctor injects special cement into your spine. This strengthens it and reduces pain.

Balloon kyphoplasty is similar but the doctor puts little balloons into your spine. They slowly inflate the balloons so that the spinal bones go back to as near normal height as possible. The doctor then injects special cement into the space created by the balloon. This can strengthen your bone, relieve pain and restore some height. 

Other treatments for spinal fractures include:

  • surgery to strengthen or repair weak or broken bones
  • radiotherapy to slow down the damage and help your pain
  • wearing a neck brace or back brace to support your neck or spine and to relieve pain  

Treatment for kidney problems

Some people with myeloma have kidney damage. It might be a problem at diagnosis, or you might develop this problem at a later time.

Causes
Kidney damage happens for different reasons.

Myeloma cells make an abnormal protein called paraprotein. These block the small tubes in the kidney that filter urine, causing damage to the kidney. This is the most common way for myeloma cells to damage the kidney.

Another reason is that myeloma causes bone disease or damage. Bones contain calcium. As the bones are damaged, high levels of calcium are released into the blood. As the blood passes through the kidneys it can cause damage. 

Some drugs such as non steroidal anti inflammatory drugs (NSAIDS) may also affect the kidneys. So your doctor might advise you not to take these.

Dehydration can make the situation worse, so it is important to drink as much as you can. Doctors generally encourage patients with myeloma to drink 2 to 3 litres each day.

Symptoms
The symptoms of kidney damage include: 

  • thirst
  • loss of appetite
  • feeling or being sick
  • passing much more or much less urine than usual
  • swollen ankles
  • breathing problems

It is very important to let your doctor or nurse know of any new symptoms as soon as you notice them. They will do regular blood tests to monitor how well your kidneys are working. They are likely to notice early changes in how your kidneys are working before you have any symptoms.

Treatment
Kidney damage often improves with fluids into your vein, and other treatments. The main treatment is treating the myeloma itself, because this is the cause of the kidney damage. You might need to see a kidney specialist. Kidney specialists are called renal doctors.

Some people with myeloma need haemodialysis, usually 3 times a week. Dialysis is a treatment that removes waste products and extra fluid from the body when the kidneys stop working. It is usually a temporary treatment, but can be permanent for some people.

Treatment for nerve problems (peripheral neuropathy)

Tingling, numbness or burning sensation in your fingers and toes can be a sign of damage to the nerves. This is called peripheral neuropathy. For myeloma, it is often because of treatments such as thalidomide and bortezomib. But it might also be caused by:

  • the myeloma itself 
  • other medical conditions 

Peripheral neuropathy can also cause nerve pain or loss of sensation,  and might also affect your balance. It most commonly affects your feet and hands, but it may also affect nerves elsewhere in your body. 

Your team will check for signs of peripheral neuropathy during treatment. Let them know if you notice any new symptoms. This is important as it might affect the dose you have.

Nerve pain

There are medicines (such as gabapentin and pregabalin) that can help with nerve pain. Painkillers such as paracetamol might also help. Or a cream called capacisin can be useful in some people.

Peripheral neuropathy as a result of treatment is often temporary. It might improve once treatment stops, or when the doctors reduce the drug dose. Rarely, these effects can be permanent in some people. 

Treatment for symptoms caused by thickened blood (hyperviscosity)

The myeloma cells produce an increased amount of protein (paraprotein). The extra protein in the blood can make the blood thicker. The thicker blood circulates around the body slower than normal. This is called hyperviscosity. It rare to have this problem with myeloma.

Hyperviscosity can clog up small blood vessels. This can cause symptoms such as confusion, dizziness, headaches and stroke like symptoms. This is due to the thickened blood blocking very small blood vessels in the brain.

Treatment with plasmapheresis
Plasmapheresis (or plasma exchange) is a procedure that you can have in the day unit. It quickly removes the excess protein from the blood.  Your nurse or technician connects you to the plasmapheresis machine. They use 2 tubes similar to the infusion tubes used for drips. One tube takes your blood into the machine and the other gives it back into your vein.

The machine separates the blood cells from the blood plasma Open a glossary item. The protein is in the plasma. The machine replaces the plasma with a solution that is very similar to normal plasma. It is given back to you with your blood cells. This process takes 2 to 3 hours.

You can have this treatment more than once if you need to. Your doctor will closely monitor your protein levels.

Treatment for tiredness (fatigue)

Fatigue means tiredness and lack of energy. It is a common symptom of myeloma and affects everyone differently.

Fatigue can be due to anaemia or might be a side effect of treatment. It may be mild or it can impact greatly on your daily life. For some people it affects their memory and their concentration. It can also cause low moods and feeling irritable. and it can make you to feel weak and have difficulty sleeping.

Your doctor can assess you and try to treat any underlying cause of your tiredness. If your myeloma treatment is making your fatigue worse, this should improve once treatment finishes.

There are things you can do that might help you cope with fatigue. 

Help controlling symptoms

Your doctor or specialist nurse can:

  • give you medicines
  • get equipment that you need
  • suggest other ways of controlling your symptoms
  • refer you to a symptom control team (a palliative care team)

Symptom control team

Members of this team are experts in controlling symptoms. They can help you to stay as well as possible for as long as possible. There are symptom control teams in most cancer units. They are also in hospices and many general hospitals.

Most symptom control teams have home care services so they can visit you at home.

  • Myeloma: diagnosis and management
    National Institute of Health and Care Excellence (NICE), 2016 (Updated 2018)

  • Pan-London Haemato-Oncology Clinical Guidelines: Plasma Cell Disorders
    North Central and East London Cancer Alliance and others
    January 2020

  • Multiple myeloma: EHA-ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up
    M Dimopoulos  and others
    Annals of Oncology, 2021. Volume 32, Issue 3, Pages 309-322

  • Guidelines for screening and management of late and long-term consequences of myeloma and its treatment
    J A Snowden and others
    British Journal of Haematology, 2017. Volume 176, Issue 6, Pages 888 - 907

Last reviewed: 
01 Dec 2023
Next review due: 
01 Dec 2026

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