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Doctor discussing multiple myeloma symptoms with patient.

A soft, fatty tissue found inside the bones throughout the body, bone marrow contains specialized cells that produce blood cells and platelets. Multiple myeloma is a relatively uncommon form of cancer that develops in certain white blood cells (plasma cells) in the bone marrow. As cancerous plasma cells (myeloma cells) form and build up in the bone marrow, the abnormal cells can start to crowd out healthy red blood cells, white blood cells and platelets. Additionally, multiple myeloma can increase the activity of cells that break down bone (osteoclasts) and decrease the activity of cells that form new bone (osteoblasts). As a result, the breakdown of existing bone can eventually outpace the formation of new bone.

What is the first sign of multiple myeloma?

Multiple myeloma does not always produce symptoms, especially in its early stages. In many cases, the condition is discovered through a routine urinalysis or bloodwork performed for an unrelated reason. As multiple myeloma progresses, the myeloma cells can begin to outnumber the healthy blood cells, which can interfere with the function of the healthy cells and lead to the development of various health problems.

Multiple myeloma can present with vague symptoms such as bone pain, fatigue and shortness of breath. Please talk with your doctor if you think you are having these symptoms.
Dr. Brandon Blue
Malignant Hematology Program

What are the symptoms of multiple myeloma?

Multiple myeloma symptoms tend to develop gradually over time and may not become apparent until the condition reaches an advanced stage. The most common symptom of multiple myeloma is bone pain, particularly in the spine and ribs.

Other early signs of multiple myeloma include:

  • Nausea
  • Constipation
  • Loss of appetite
  • Fatigue
  • Weakness
  • Frequent infections
  • Excessive thirst
  • Unintended weight loss

End-stage multiple myeloma symptoms are often referred to as CRAB symptoms, which include:

  • C – increased blood calcium levels
  • R – renal (kidney) dysfunction
  • A – anemia
  • B – bone lesions

What health conditions can occur with multiple myeloma?

Abnormal cellular activity in the bone marrow can trigger a cascade of medical issues, such as:


Anemia is often one of the first symptoms of multiple myeloma. As myeloma cells interfere with the bone marrow’s production of healthy blood cells, a shortage of red blood cells (anemia) may occur. Red blood cells contain hemoglobin, which is essential for transporting oxygen from the lungs to organs and tissues throughout the body.

The symptoms of anemia include:

  • Shortness of breath
  • Exhaustion
  • Headache
  • Dizziness
  • Leg swelling


Multiple myeloma can cause a deficiency of infection-fighting white blood cells (leukopenia). In addition to frequent bacterial, viral and fungal infections, leukopenia can cause:

  • Fever
  • Chills
  • Excessive sweating


Multiple myeloma can also cause a low platelet count. Platelets are tiny blood cells that help the blood clot by clumping together and forming a plug to effectively seal a wound.

The symptoms of thrombocytopenia include:

  • Easy bruising
  • Superficial bleeding into the skin that forms tiny reddish spots (petechiae)
  • Chronic nosebleeds
  • Bleeding gums
  • Blood-tinged urine or stool
  • Spleen enlargement


Because multiple myeloma can hasten the bone resorption process, it can lead to high blood calcium levels. Hypercalcemia symptoms include:

  • Nausea and vomiting
  • Loss of appetite
  • Increased thirst
  • Frequent urination
  • Constipation
  • Muscle weakness and twitching

Hyperviscosity syndrome

Myeloma cells produce various types of abnormal proteins, such as M-proteins. As M-proteins accumulate in the bloodstream, the blood may become thick and sticky. As a result, the blood will flow more slowly.

The symptoms of hyperviscosity syndrome include:

  • Headaches
  • Chronic nosebleeds
  • Easy bruising
  • Gastrointestinal bleeding
  • Overwhelming fatigue
  • Vision problems, such as retinopathy


Cryoglobulins are another type of abnormal protein produced by myeloma cells that can build up in the blood. When exposed to cold temperatures, cryoglobulins thicken or gel.

The symptoms of cryoglobulinemia include:

  • Joint pain (arthralgia)
  • Pain and numbness in the fingers and toes when exposed to cold temperatures (Raynaud’s syndrome)
  • Purple spots on the skin and mucus membranes (purpura)
  • Weakness


Healthy plasma cells normally produce antibodies to help the body fight off infections. Myeloma cells sometimes produce extra pieces of antibodies known as monoclonal light chains. The light chains then circulate in the bloodstream and can deposit in—and interfere with the function of—various organs, nerves and tissues throughout the body, such as the heart, kidneys, skin and tongue.

Renal failure

Light chains produced by myeloma cells build up in and block the kidneys, which can impair their water-filtering function and eventually lead to renal failure. The symptoms include:

  • Decreased urine output
  • Leg and ankle swelling
  • Shortness of breath
  • Fatigue
  • Confusion
  • Nausea
  • Weakness
  • Irregular heartbeat
  • Chest pain or pressure

Talk with a specialist at Moffitt Cancer Center

If you would like to discuss your multiple myeloma symptoms with a specialist at Moffitt Cancer Center, call 1-888-663-3488 or use our convenient new patient registration form online to request an appointment. A referral is not required. Our Malignant Hematology Program features a multispecialty team that focuses on diagnosing and treating multiple myeloma and its symptoms. We offer the latest diagnostic, treatment and supportive care services in one convenient location. As Florida’s top cancer hospital, Moffitt is changing the model, and we provide every new patient with rapid access to a cancer expert as soon as possible.


National Organization for Rare Disorders: Multiple Myeloma
International Myeloma Foundation: Multiple Myeloma and Anemia
International Myeloma Foundation: Kidney Failure