By: Prof. Dr. Seyed Saeid Zamanieh Shahri, MD  and  Prof. Dr. Sonia Sayyedalhosseini, MD

Bone marrow cancer:

Multiple myeloma is formed in white blood cells known as plasma cells and causes the appearance of cancer cells in the bone marrow. Over time, these cancer cells cause the destruction of healthy plasma cells, which are responsible for fighting infections and producing antibodies needed to fight germs and infection. Instead, the cancer cells produced by multiple myeloma led to the production of abnormal proteins, which ultimately lead to significant health problems for those affected, especially kidney problems.

Anatomy and physiology:

Bone marrow is a spongy tissue inside the bones. Bone marrow contains stem cells that develop into the types of blood cells found in the body, including:

Red Blood Cells that carry oxygen and carbon dioxide throughout the body;

White Blood Cells that fight infections;

Platelets that help blood clot;

The body usually produces these Red Blood Cells when needed, such as when old Red Blood Cells die. Sometimes these cells grow at an excessive or abnormal rate, which is known as bone marrow cancer.

Signs and symptoms:

۱) Excessive fatigue: One of the first symptoms of multiple myeloma is the feeling of excessive fatigue that does not go away even after adequate rest and following a healthy diet. This feeling of fatigue is caused by the way multiple myeloma attacks healthy cells in the bone marrow, which in many cases can lead to anemia or inappropriate cytokine production. Because fatigue is so common, this symptom should be considered in conjunction with the other multiple myeloma symptoms listed below. For example, a person with a family history of cancer, especially multiple myeloma, should be tested for this disease if they experience fatigue for several days or weeks.

۲) severe anemia: Occurs when the number of Red Blood Cells drops to very low levels. It can be caused by multiple myeloma, as the disease suppresses or expels healthy Red Blood Cells. The most common side effect of severe anemia is feeling very tired, which may not go away with following a healthy diet, getting enough rest, drinking fluids, or stimulants like caffeine. This feeling of excessive fatigue can last for days or even weeks. However, it should be noted that anemia is not only associated with multiple myeloma and bone marrow cancer. Many reasons can cause anemia, from pregnancy to menstruation, and iron and vitamin deficiency.

۳) Pain in the bones: One of the clear and distinctive signs of multiple myeloma is pain in the bones. Multiple myeloma forms in the bone marrow and over time suppresses healthy Red Blood Cells, which can lead to bone thinning and weakening. As a result, osteoporosis is formed. By reaching this stage, the likelihood of the affected bone cracking or breaking completely increases significantly. Also, this condition leads to mild to moderate pain in and around the bone. If key and important bones, such as the spine, which is responsible for supporting several parts of the body, are affected by the disease, this pain may be more evident. This pain increases with movement and may worsen significantly at night and early in the morning.

۴) Numbness: Since multiple myeloma targets healthy Red Blood Cells in the bone marrow, it can weaken the patient’s bones. These conditions often cause fragility and pain in the bones, and can also lead to numbness. This feeling of numbness is mostly formed when the multiple myeloma attacks the vertebrae of the spine. As the problem spreads in the spine, the disease weakens the bones and the vertebrae come into contact with each other and the nerves around the spine. In contact with these very sensitive nerves, multiple myeloma disrupts the signals that move between the brain and the spine and causes numbness in that area.

۵) Kidney problems: Multiple myeloma can eventually lead to significant kidney problems. The development of multiple myeloma leads to the formation of proteins whose excessive production can put extra pressure on the kidneys and cause them to be damaged or even cause kidney failure. Ideally, the patient recognizes the signs and symptoms of multiple myeloma and takes the necessary measures before the disease leads to kidney problems.

۶) Hypercalcemia: Over time, multiple myeloma leads to the production of cancer cells, which causes healthy cells to leave the bone marrow. This condition causes weakness, pain and potentially numbness in the bone. At this time, the disease can cause cracking or complete bone fracture. Also, this bone erosion as a result of multiple myeloma disease leads to the formation of a condition called hypercalcemia or excessive calcium, which results in an excessive amount of calcium in the blood. Hypercalcemia is often seen in people with multiple myeloma. Hypercalcemia manifests itself with symptoms such as excessive fatigue, constipation, and kidney problems.

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