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Comorbidities and Complications of Multiple Myeloma

Posted on March 08, 2022
Medically reviewed by
Richard LoCicero, M.D.
Article written by
Maureen McNulty

Many people already have other health conditions by the time they are diagnosed with multiple myeloma. Other people develop diseases during or after myeloma treatment. These other conditions may affect your quality of life, limit your myeloma treatment options, and impact your prognosis.

Comorbidities and Complications

When a second health condition develops as the result of a first disease or its treatments, it is called a complication. Common complications that can occur as a result of multiple myeloma include:

  • Hypercalcemia (elevated calcium levels in the blood)
  • Kidney problems
  • Anemia (low red blood cell counts)
  • Bone problems, such as osteoporosis, bone pain, and fractures

Two or more health conditions that occur at the same time are known as comorbidities. If a person with multiple myeloma has a complication or comorbidity, they may be more sick and have a harder time tolerating myeloma treatments. One study found that more than half of people with multiple myeloma had comorbidities at the time of diagnosis.

Age often plays a role in whether a person has comorbid conditions. The longer someone lives, the higher their chance of having a chronic illness. Multiple myeloma is more likely to affect older adults, who may already have other health conditions. In one study, people who were diagnosed with multiple myeloma were also more likely to have other chronic disorders that also increase with age. For example, 20.4 percent had high blood pressure and 8.4 percent had diabetes.

Kidney Failure

Many people with multiple myeloma have renal impairment (kidney problems). The kidney filters toxins, wastes, and extra fluid out of the blood. When the kidney is damaged, it may not perform these jobs as well as it should. This condition is called chronic kidney disease. Over time, chronic kidney disease may progress to kidney failure, also known as end-stage renal disease. Kidney failure occurs when the kidneys stop working. At this point, a person will need a kidney transplant or regular dialysis treatments, during which a machine helps filter the blood.

As many as half of people with multiple myeloma develop kidney problems. For about 85 percent of these people, kidney disease is caused by blocked tubules (tiny tubes in the kidneys). During multiple myeloma, cancerous plasma cells produce too many antibody proteins. These proteins enter the bloodstream and can clog up the tubules, causing nearby kidney tissue to become inflamed and damaged.

For the other 15 percent of people with myeloma who have kidney problems, other risk factors are to blame. These include:

  • Having other comorbidities, such as diabetes, infections, or artery disease
  • Smoking
  • Having hypercalcemia (high calcium levels in the blood)
  • Taking some medications, including nonsteroidal anti-inflammatory drugs and myeloma treatments
  • Not drinking enough water

Those who are older or have more severe multiple myeloma are more likely to experience kidney problems.

Myeloma treatments, including the chemotherapy drug Velcade (bortezomib) and autologous stem cell transplantation, can reduce the levels of abnormal protein in the blood and help the kidneys work better. When people with multiple myeloma develop kidney failure or need to have dialysis treatments, they are more likely to have a poor prognosis (outlook).

Read more about kidney failure and myeloma.

Heart Problems

People with multiple myeloma often have heart conditions before cancer develops. This is especially true for older adults. One study looked at which comorbidities a person already had by the time they were diagnosed with myeloma. Researchers found that some of the most common comorbidities were cardiovascular problems (issues related to the heart or blood vessels). These included:

  • Hypertension (high blood pressure)
  • Arrhythmia (an irregular heartbeat)
  • Coronary artery disease (blood vessel narrowing that prevents the heart from getting enough blood)

Other people with myeloma develop heart problems after taking certain cancer therapies. Several types of chemotherapy, targeted therapy, and immunomodulatory drugs can cause heart problems as a side effect. These treatments may lead to conditions such as hypertension, heart attack, and heart failure. People who develop heart problems may need to change their myeloma treatment plan or take additional medications to support their heart health.

People with heart conditions should have regular follow-up visits with their cardiologists while undergoing treatment for myeloma.

Lung Problems

Those living with myeloma may also have other existing disorders that prevent the lungs from working as they should. One study found that about 18 percent of people with multiple myeloma were diagnosed with disorders that affect the lungs. These disorders can include asthma and chronic obstructive pulmonary disease.

Another study found that about 45 percent of people with myeloma had problems with lung function, even if they hadn’t been diagnosed with a specific lung disorder. These lung problems often make it harder for people with myeloma to undergo treatment and can lead to poor outcomes.

People with myeloma should work with their health care team to treat any existing lung disorders. This may help people better tolerate their myeloma treatments and have a better quality of life.

Venous Thromboembolism

People with myeloma may be at risk for developing venous thromboembolism (VTE). VTE is a condition in which a blood clot forms and prevents blood from flowing through a blood vessel. There are two main types of VTE:

  • Deep vein thrombosis (DVT) — A blood clot that often forms in the legs but that can also form in the arms or other veins in the body
  • Pulmonary embolism (PE) — A condition in which a blood clot travels to the lungs and prevents blood from reaching part of the lung tissue

DVTs can cause pain, swelling, tightness, skin discoloration, or skin warmth at the site of the blood clot. A lump may also form. These symptoms may also be accompanied by a fast heartbeat. When a person develops a PE, they may experience chest pain, shortness of breath, a rapid heart rate, or feelings of anxiety.

Certain myeloma drugs increase the chance that a person will develop VTE. People taking immunomodulatory drugs such as Thalomid (thalidomide), Pomalyst (pomalidomide), or Revlimid (lenalidomide) in addition to Decadron (dexamethasone) are six times more likely to develop a blood clot. Doctors usually recommend that people using this treatment plan also take an anticoagulant drug — a blood thinner — to help prevent clotting. Regularly exercising, drinking a lot of water, and using compression stockings can also help reduce the risk of DVT and PE.

DVTs and PEs can be serious. They may lead to long-lasting health problems, and they can be fatal. If you notice possible symptoms, get immediate medical care. DVTs and PEs can usually be treated with medication or, in severe cases, surgery.

Liver Failure

The liver helps digest food, makes proteins, stores energy, and removes toxins from the blood. Liver failure develops when the liver becomes damaged and can’t carry out these tasks. Liver failure can lead to:

  • Nausea
  • Loss of appetite
  • Tiredness
  • Diarrhea
  • Blood in the stool or vomit
  • Jaundice (yellowing of the skin and whites of the eyes)
  • Swelling in the abdomen, arms, and legs

As many as 2 out of 5 people with myeloma have liver problems, including liver failure. This may occur when cancerous plasma cells build up within the liver and cause damage.

Liver failure may be treated with intravenous fluids and blood sugar level monitoring. Medications may also help get rid of toxins that the liver can’t remove. Severe cases of liver failure may require a blood transfusion (receiving blood from a donor), use of a breathing tube, or a liver transplant.

Depression and Anxiety

People who live with cancer often experience mood disorders such as depression or anxiety. One study found that about 22 percent of people with myeloma had symptoms of depression and that nearly 36 percent had symptoms of anxiety. Those with depression or anxiety have a higher risk of experiencing additional myeloma symptoms and needing more hospital visits.

Many different factors can contribute to depression or anxiety in people with cancer. Those who receive a myeloma diagnosis may experience upsetting body changes, feel stressed about paying for treatment, have to change their plans for the future, and have to deal with end-of-life planning. These factors can all lead to mental health struggles.

While everyone feels sad or upset after a cancer diagnosis, depression goes beyond normal feelings of sadness. Symptoms of depression may look like:

  • Feeling sad or worried most of the time
  • Feeling guilty or worthless
  • Losing interest in activities you used to like
  • Eating more or less than you used to
  • Sleeping more or less than usual
  • Feeling tired or slow
  • Having “brain fog” symptoms, including difficulties concentrating or remembering
  • Thinking about death or suicide

Those with multiple myeloma may also struggle with anxiety. This can lead to constant feelings of worry, stress, or restlessness. People with anxiety may also have problems with brain fog and with regulating their emotions. They may be unusually irritable or angry.

Some symptoms of depression and anxiety, such as eating changes, sleeping changes, and brain fog, can also occur as a result of cancer treatments like chemotherapy. Talk to your doctor if you notice mental health changes. Your doctor may recommend taking medication or going to therapy or counseling. Participating in support groups may also boost mental health. Following a steady routine, eating a balanced diet, and getting regular physical activity may also help when dealing with anxiety and depression.

Other Complications From Myeloma Treatment

Multiple myeloma therapies can cause several other complications and side effects, including:

  • Anemia — Low levels of red blood cells, which can lead to tiredness and shortness of breath
  • Neutropenia — Low levels of white blood cells, which cause a higher risk of infections
  • Thrombocytopenia — Low platelet levels, which sometimes lead to bleeding problems
  • Bone pain — Pain caused by cancerous plasma cells growing in the bones and bone marrow (spongy tissue found inside of certain bones)
  • Peripheral neuropathy — Nerve damage leading to pain, tingling, or weakness in the legs or arms
  • Hyperviscosity syndrome — A condition in which too many proteins in the blood make it thicker, leading to dizziness, tiredness, and headaches
  • Additional cancers such as leukemia

Palliative care aims to treat or prevent these side effects and relieve myeloma symptoms. It might include additional medications, nutritional support, mental health care, or financial or social support. A person can use palliative care at any stage of their treatment journey.

The Impact of Comorbidities

To assess the impact of a person’s comorbidities, doctors have developed a tool called the revised Myeloma Comorbidity Index (R-MCI). This tool takes into account a person’s age, overall health, and how well their lungs and kidneys work. Using the R-MCI, doctors can assign a score that classifies people into low-, intermediate-, or high-risk groups. This information helps doctors estimate prognosis and develop a treatment plan.

People with multiple comorbidities and a higher R-MCI score usually have a worse outlook. They have a higher chance of early death. Additionally, the more comorbidities a person with myeloma has, the worse their prognosis tends to be.

The R-MCI also helps show which myeloma treatment options may be most helpful. People with comorbidities may not be able to tolerate aggressive therapies. Those with a high R-MCI score may want to choose therapies that come with fewer side effects and that are less likely to cause additional health issues.

If you have other health conditions, work with your oncologist and health care team to make sure all of your health conditions are being treated. Managing comorbidities may help you have a better chance at a good outcome — and a better quality of life.

Condition Guide

References
  1. Complication — National Cancer Institute
  2. Comorbidity — National Cancer Institute
  3. Ageing and the Epidemiology of Multimorbidity — The European Respiratory Journal
  4. A Concise Revised Myeloma Comorbidity Index as a Valid Prognostic Instrument in a Large Cohort of 801 Multiple Myeloma Patients — Haematologica
  5. Comorbidities in Multiple Myeloma and Implications on Survival: A Population-Based Study — European Journal of Haematology
  6. Chronic Kidney Disease — Mayo Clinic
  7. Kidney Failure, End-Stage Kidney Disease (ESKD), or End-Stage Renal Disease (ESRD) — American Kidney Fund
  8. Renal Failure in Multiple Myeloma: A Medical Emergency — Bone Marrow Transplantation
  9. Kidney Failure — International Myeloma Foundation
  10. Heart and Lung Complications — International Myeloma Foundation
  11. Comorbidity as a Prognostic Variable in Multiple Myeloma: Comparative Evaluation of Common Comorbidity Scores and Use of a Novel MM-Comorbidity Score — Blood Cancer Journal
  12. Real-World Treatment Patterns and Outcomes Among Multiple Myeloma Patients With Asthma and COPD in the United States — Oncology and Therapy
  13. Pulmonary Function Abnormalities Are Common in Patients With Multiple Myeloma and Are Independently Associated With Worse Outcome — Annals of Hematology
  14. What Is VTE? — Centers for Disease Control and Prevention
  15. Liver Failure — Cleveland Clinic
  16. Rapidly Progressive Acute Liver Failure in Relapsed Multiple Myeloma — Cureus
  17. Prevalence of Symptoms in Patients With Multiple Myeloma: A Systematic Review and Meta-Analysis — European Journal of Haematology
  18. Prevalence of Depression and Anxiety in Older Patients With Multiple Myeloma in North Carolina: A Population-Based, Claims-Based Assessment — Journal of Clinical Oncology
  19. Depression in Cancer Patients: What You Should Know — MD Anderson Cancer Center
  20. Anxiety — American Cancer Society
  21. Supportive Care and Disease Complications — Leukemia & Lymphoma Society
  22. What Is Palliative Care? — Cancer.Net
All updates must be accompanied by text or a picture.
Richard LoCicero, M.D. has a private practice specializing in hematology and medical oncology at the Longstreet Clinic Cancer Center, in Gainesville, Georgia. Review provided by VeriMed Healthcare Network. Learn more about him here.
Maureen McNulty studied molecular genetics and English at Ohio State University. Learn more about her here.

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