Multiple myeloma is cancer of the plasma cells in the blood and bone marrow. When these cells begin to overgrow, they leave little space for the bone marrow to be able to adequately produce other blood cells. These other blood cells include white blood cells, blood-clotting platelets, and red blood cells, which make hemoglobin. Hemoglobin transports oxygen around the body, and when hemoglobin is low, it is referred to as anemia. People with multiple myeloma may also have kidney damage. The kidneys produce a signal that stimulates the bone marrow to make red blood cells. Without that signal, red cell numbers may decrease and there may be anemia.
Anemia is a common finding in someone living with multiple myeloma, with 60 percent to 70 percent of people having anemia at the time of diagnosis. Anemia is often found during a routine blood draw or an investigation of myeloma symptoms.
Anemia in multiple myeloma can be caused by multiple factors. Anemia may be caused by the myeloma, or because of damage that multiple myeloma has caused to the kidneys. Anemia may also be a side effect of the medications given to treat the myeloma, or it may be caused by nutritional deficiencies.
Blood cells are made inside the bone marrow, the spongy tissue found inside certain bones of the body. One type of blood cell is the plasma cell — part of the body’s immune system. Plasma cells develop from infection-fighting B cells and make antibodies, which fight off infections in the body. In addition to plasma cells, the bone marrow also makes white blood cells, red blood cells, and platelets.
When the plasma cells become cancerous, they grow rapidly and uncontrollably in the bone marrow. As the bone marrow becomes full of cancerous plasma cells, there isn’t enough space for the other, healthy blood cells to grow. This lack of space for red blood cells then causes anemia to develop.
The kidneys play an important role in hemoglobin production. When the kidneys sense decreasing red blood cell counts, they signal the bone marrow to make more red blood cells, by releasing a protein signal called erythropoietin. Multiple myeloma often causes damage to the kidneys when the abnormal proteins and light chains produced by cancer build up in the kidneys. One may or may not be able to see this damage in blood test results. As a result, the kidneys cannot work properly, and kidney dysfunction develops. As kidney function decreases due to these abnormal proteins, the kidneys send off less erythropoietin, and the bone marrow doesn’t produce enough red cells.
Many different therapies can treat multiple myeloma. These medications may be chemotherapy or may be in the class of immunomodulating medications, proteasome inhibitors, or monoclonal antibodies. These medications work in different ways to treat multiple myeloma. However, many of these medications may lead to the development of anemia as a side effect of the treatment.
There may be other factors that contribute to anemia, such as deficiencies in iron, vitamin B12, or folate. Often, these may be present in addition to multiple myeloma. These nutritional deficiencies may occur due to decreased food intake or because of decreased absorption of nutrients through the gastrointestinal tract.
Anemia can have a significant impact on how someone feels and can cause a variety of symptoms. Hemoglobin takes oxygen around the body, and when there isn’t enough hemoglobin to oxygenate as the body needs, symptoms may develop. These symptoms may include:
Many MyMyelomaTeam members have experienced anemia and described how anemia has affected their quality of life:
Treating anemia associated with multiple myeloma typically depends on the initial cause of the anemia. Blood transfusions may be required for people with severe anemia and help very quickly. A blood transfusion is a procedure in which someone receives blood that has been donated by another person. Transfusion can quickly improve the hemoglobin count and may quickly relieve symptoms associated with anemia. If the underlying cause of anemia is not treated, multiple blood transfusions may be necessary.
If the anemia is caused by multiple myeloma crowding out the bone marrow, treating the myeloma will ultimately improve the anemia. When treatment begins working, the abnormal plasma cells begin to die, and more space becomes available for normal cells in the bone marrow. Over time, the bone marrow can produce adequate amounts of hemoglobin
If anemia is caused by multiple myeloma treatment, giving the body time to recover from therapy may be required to allow the bone marrow to heal. If anemia is severe, the oncology team may make adjustments in the doses of medications being given to allow for treatment without significant anemia as a side effect.
Giving weekly or biweekly injections of erythropoietin under the skin provides the signal that is missing and leads to increased production of red cells.
Anemia caused by nutritional deficiencies such as iron, vitamin B12, or folate can be treated by supplementing these nutrients. Iron may be supplemented through intravenous infusion or oral pills. Folate is given through oral supplementation, and vitamin B12 may be given orally or through injection.
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