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{{Multiple myeloma}}
{{Multiple myeloma}}
{{CMG}}
{{CMG}} {{AE}} {{HMHJ}}; {{HL}}; {{shyam}}
 
==Overview==
==Overview==
The signs and symptoms of multiple myeloma are most commonly associated with either elevation in [[calcium]] concentrations, [[renal failure]], [[anemia]] and involvement of the [[bone]]s such as fractures and pains.
The history and symptoms of [[multiple myeloma]] are based on the underlying effect of excess [[plasma cells]] on various [[Organ (anatomy)|organ]] systems. Pain is usually a symptom of newly diagnosed [[multiple myeloma]]. Broad categories of [[Symptom|symptoms]] include bone-related [[Symptom|symptoms]], [[neurological]] [[Symptom|symptoms]], [[hypercalcemia]]-related [[symptoms]], [[bone marrow failure]]-related [[symptoms]], and [[thrombosis]]-related [[Symptom|symptoms]]. Although all of these [[symptoms]] are possible, the presentation of [[multiple myeloma]] varies from [[patient]] to [[patient]].


==History and Symptoms==
==History and Symptoms==
Early multiple myeloma does not have any symptoms. In as many as 30-40% cases the diagnosis may be incidental and is often diagnosed on routine blood screening. A rise in total protein levels without a concomitant rise in albumin levels must make the physician suspicious for a possibility of multiple myeloma. As the tumor grows larger, people may notice one or more of the following symptoms:  
Relevant history includes:
:*[[Bone pain]]
*Review of past medical history for other [[plasma cell]] diseases, [[hematologic]] [[malignancies]], underlying [[Kidney|renal]] [[disease]], and underlying [[bone]] [[disease]]
:* Pathological fractures
*Review of [[family]] history for members with positive history of [[hematologic]] [[malignancies]]
:*[[Numbness]] and/or [[muscle weakness]]
*Review of occupational history related to farming, oil industry, or [[Agent Orange]] exposure
:*[[Confusion]]
:*[[Dizziness]]
:*[[Edema]] in legs
:* Back pain, numbness, [[dysthesias]] suggestive of [[spinal cord compression]].
:* Bleeding
:* Recurrent infections


History includes character, location, onset, and duration of [[pain]] (typically [[Bone pain|bony pain]]). Symptoms of [[multiple myeloma]] include:<ref name="wiki">Multiple myeloma. Wikipedia (2015) https://en.wikipedia.org/wiki/Multiple_myeloma#Signs_and_symptoms Accessed on September, 20th 2015</ref><ref name="canada">Multiple myeloma. Canadian Cancer Society (2015) http://www.cancer.ca/en/cancer-information/cancer-type/multiple-myeloma/signs-and-symptoms/?region=mb Accessed on September 20th 2015</ref><ref name="gov">Multiple myeloma. Cancer. gov(2015) http://www.cancer.gov/types/myeloma Accessed on September, 20th 2015</ref><ref name="pmid24614435">{{cite journal |vauthors=Reisenbuckler C |title=Multiple myeloma and diagnostic imaging |journal=Radiol Technol |volume=85 |issue=4 |pages=391–410; quiz 411–3 |date=2014 |pmid=24614435 |doi= |url=}}</ref><ref name="pmid26294217">{{cite journal |vauthors=Sergentanis TN, Zagouri F, Tsilimidos G, Tsagianni A, Tseliou M, Dimopoulos MA, Psaltopoulou T |title=Risk Factors for Multiple Myeloma: A Systematic Review of Meta-Analyses |journal=Clin Lymphoma Myeloma Leuk |volume=15 |issue=10 |pages=563–77.e1–3 |date=October 2015 |pmid=26294217 |doi=10.1016/j.clml.2015.06.003 |url=}}</ref><ref name="pmid24130968">{{cite journal |vauthors=Eslick R, Talaulikar D |title=Multiple myeloma: from diagnosis to treatment |journal=Aust Fam Physician |volume=42 |issue=10 |pages=684–8 |date=October 2013 |pmid=24130968 |doi= |url=}}</ref>


Because many organs can be affected by multiple myeloma, the symptoms and signs vary greatly. A [[mnemonic]] sometimes used to remember the common tetrad of multiple myeloma is ''CRAB'' - C = Calcium (elevated), R =Renal failure, A = Anemia, B = Bone lesions.<ref name="IMWG">International Myeloma Working Group. ''Criteria for the classification of monoclonal gammopathies, multiple myeloma and related disorders: a report of the International Myeloma Working Group.'' Br J Haematol 2003;121:749-57. PMID 12780789.</ref> Multiple myeloma has many possible symptoms, and all symptoms may be due to other causes. They are presented here in decreasing order of incidence.
:*[[Bone pain]]
 
::*Usually involves the [[spine]] and [[ribs]] ([[axial skeleton]]), and worsens with activity
;Bone pain
::*Persistent localized [[pain]] may indicate a pathological [[bone fracture]]
Multiple myeloma bone pain usually involves the spine and ribs, and worsens with activity. Persistent localized pain may indicate a pathological [[bone fracture]]. Involvement of the vertebrae may lead to [[spinal cord compression]]. Multiple myeloma bone disease is due to proliferation of tumor cells and release of [[Interleukin 6|IL-6]], also known as osteoclast activating factor (OAF), which stimulates [[osteoclast]]s to break down bone. These bone lesions are lytic in nature and are best seen in plain radiographs, which may show a "punched-out" resorptive lesions. The breakdown of bone also leads to release of [[calcium]] into the blood, leading to [[hypercalcemia]] and its associated symptoms.
::*Inability to carry out routine tasks due to limitation by [[pain]]
 
;Infection
The most common infections are [[pneumonia]]s and [[pyelonephritis]]. Common pneumonia pathogens include ''[[streptococcus pneumoniae|S pneumoniae]]'', ''[[staphylococcus aureus|S aureus]]'', and ''[[klebsiella pneumoniae|K pneumoniae]]'', while common pathogens causing pyelonephritis include ''[[escherichia coli|E coli]]'' and other [[gram-negative]] organisms. The increased risk of infection is due to immune deficiency resulting from diffuse [[hypogammaglobulinemia]], which is due to decreased production and increased destruction of normal [[antibody|antibodies]].
 
;Renal failure
[[Renal failure]] may develop both [[acute renal failure|acutely]] and [[chronic renal failure|chronically]]. It is commonly due to [[hypercalcemia]] (see above). It may also be due to tubular damage from excretion of [[light chain]]s, also called [[Bence Jones protein]]s, which can manifest as the [[Fanconi syndrome]] (type II [[renal tubular acidosis]]). Other causes include glomerular deposition of [[amyloid]], [[hyperuricemia]], recurrent infections ([[pyelonephritis]]), and local infiltration of tumor cells.
 
;Anemia
The [[anemia]] found in multiple myeloma is usually normocytic and normochromic. It results from the replacement of normal bone marrow by infiltrating tumor cells and inhibition of normal red blood cell production ([[hematopoiesis]]) by [[cytokines]].


;Neurological symptoms
:*Neurological symptoms
Common problems are weakness, confusion and fatigue due to [[hypercalcemia]]. [[Headache]], visual changes and [[retinopathy]] may be the result of hyperviscosity of the blood depending on the properties of the [[paraprotein]]. Finally, there may be [[radicular pain]], loss of bowel or bladder control (due to involvement of [[spinal cord]] leading to cord compression) or [[carpal tunnel syndrome]] and other [[neuropathies]] (due to infiltration of [[peripheral nerves]] by [[amyloid]]).  It may give rise to [[paraplegia]] in late presenting cases.
::*[[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


:*[[Thrombosis|Thrombotic]] symptoms: [[Thrombosis]] is more common in [[multiple myeloma]] due to [[cancer]]-associated [[thrombosis]] and due to [[lenalidomide]], which increases [[Thrombosis|thrombotic]] risk.
::*Shortness of breath due to [[pulmonary embolism]]
::*Lower [[Limb|extremity]] [[edema]] due to [[deep vein thrombosis]]
::*Abdominal pain due to mesenteric venous thrombosis
::*[[Transient ischemic attack]]
::*[[Retinal]] [[hemorrhage]]
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}


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Latest revision as of 22:47, 29 July 2020

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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]

Overview

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.

History and Symptoms

Relevant history includes:

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

  • Neurological symptoms

References

  1. ↑ Multiple myeloma. Wikipedia (2015) https://en.wikipedia.org/wiki/Multiple_myeloma#Signs_and_symptoms Accessed on September, 20th 2015
  2. ↑ Multiple myeloma. Canadian Cancer Society (2015) http://www.cancer.ca/en/cancer-information/cancer-type/multiple-myeloma/signs-and-symptoms/?region=mb Accessed on September 20th 2015
  3. ↑ Multiple myeloma. Cancer. gov(2015) http://www.cancer.gov/types/myeloma Accessed on September, 20th 2015
  4. ↑ Reisenbuckler C (2014). "Multiple myeloma and diagnostic imaging". Radiol Technol. 85 (4): 391–410, quiz 411–3. PMID 24614435.
  5. ↑ Sergentanis TN, Zagouri F, Tsilimidos G, Tsagianni A, Tseliou M, Dimopoulos MA, Psaltopoulou T (October 2015). "Risk Factors for Multiple Myeloma: A Systematic Review of Meta-Analyses". Clin Lymphoma Myeloma Leuk. 15 (10): 563–77.e1–3. doi:10.1016/j.clml.2015.06.003. PMID 26294217.
  6. ↑ Eslick R, Talaulikar D (October 2013). "Multiple myeloma: from diagnosis to treatment". Aust Fam Physician. 42 (10): 684–8. PMID 24130968.
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