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Complications of Multiple Myeloma

Multiple myeloma is cancer of the plasma cells. Bone marrow--the spongy part of the bone--produces white blood cells that fight infection. Plasma cells, a specific type of white blood cell, produce antibodies that recognize foreign matter like bacteria. In multiple myeloma, a plasma cell grows exponentially, creating identical plasma cells and identical antibodies (paraproteins) that damage the body.

  1. Immune System

    • People with multiple myeloma have compromised immune systems for two reasons: First, identical plasma cells cannot fight infection because their antibodies are abnormal; second, the overgrowth of plasma cells prohibits the growth of other types of white cells in the bone marrow that are needed to fight infection. People with multiple myeloma are susceptible to colds, pneumonia and bladder infections. When they get sick, they do not necessarily respond to medication and it takes them longer to recover.

    Bones

    • Bone cells normally work together to ensure optimal structure: osteoclasts destroy old bone, and osteoblasts create new bone. However, in multiple myeloma, osteoclasts work quickly to destroy bone, but osteoblasts fail to make new bone; the result is bone destruction. Calcium, which leaks from the structure, flows into the bloodstream and ends up in the urine. Bones are weak, painful and fragile. Fractures are a real possibility, even when minimal force is applied. The bones may wither away and compress the spinal cord, a medical emergency that can leave a person paralyzed.

    Kidneys

    • Paraprotein particles from cancerous plasma cells may find their way into the kidney's network of tiny blood vessels. Smaller particles end up in the urine; these paraproteins, or Bence Jones proteins, are one of several diagnostic markers for multiple myeloma. Larger paraproteins may get stuck in the delicate blood vessels and clog the passage, thus shutting off blood supply and causing kidney failure. Infection, high calcium levels (from bone damage) and medications (for multiple myeloma) can also cause the kidneys to fail.

    Heart

    • Abnormal plasma cells produce exponential amounts of paraproteins that eventually find their way into the bloodstream; as a result, blood becomes concentrated and viscous. The heart works much harder to pump the thick blood through circulation and to all the organs. If the workload continues indefinitely, the heart may not be able to sustain the pressure, and heart failure becomes a possibility.

    Talking About the End

    • With multiple myeloma, pain can be relentless, infections may be frequent and fractures downright scary. There are many treatment options but no cure. People with multiple myeloma eventually die, whether from infection or organ failure, so they should plan for the end. They need to get with their families and discuss end-of-life care, finances and other relevant issues.

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