Multiple myeloma treatment has one main goal: to put your disease into remission. When cancer goes into remission, the cancer cells can no longer be detected, and your symptoms usually go away. However, your doctor should prepare you for the possibility that your cancer may relapse. A relapse happens when multiple myeloma comes back after a period of remission, and your symptoms return.

Maintenance therapy can prolong remission. Unfortunately, relapsing multiple myeloma is very common — most people will relapse at some point. Although relapse may not cause any symptoms initially, the growth of myeloma cells can bring on several warning signs you should look out for.

This article will go over symptoms that you may experience due to a myeloma relapse. By knowing what symptoms you can expect, you can learn when to reach out to your doctor. They can help figure out if the symptoms are due to a relapse or a different cause altogether.

1. Infections

Multiple myeloma is a type of blood cancer that affects the plasma cells of the bone marrow. Plasma cells are a type of white blood cell that helps the body fight off infection. When myeloma cells multiply, it competes with the other blood cells, and the number of healthy white blood cells goes down. When white blood cells are low, the immune system can’t protect the body as well as usual, putting you at a high risk of getting an infection.

If you’re getting sick often or staying sick for a long time, your doctor can help you figure out why. They may order a blood test to look at your white blood cell count. If your white blood cells are lower than normal, that could mean the myeloma cells are coming back. Infections may not always manifest as a fever, cough, or cold, but they can also appear as wounds, new persistent rashes, or painful urination.

2. Bruising or Bleeding

Platelets are a type of blood cell that helps your blood form clots. When you have a cut or injury, blood clotting is what allows the bleeding to slow down and the healing process to begin. Multiple myeloma can cause low levels of platelets — known as thrombocytopenia. This condition can make you bruise easily or bleed heavily, even with minor cuts.

If you’re having problems with bleeding or bruising easily, your doctor may order a blood test to look at your platelet levels. Thrombocytopenia may be a sign of relapsed multiple myeloma.

3. Bone Problems

Because plasma cells are located in the bone marrow, a relapse can cause different issues with your bones. This can include:

• Bone lesions (injuries)
• Weak bones that break or fracture easily
• Bone pain, especially in your hips, back, or skull

Bone pain is a common sign of relapsed multiple myeloma. Contact your doctor if you’ve started having backaches or bone pain in another part of your body.

4. Neurological Problems

Myeloma cells make an abnormal antibody called M protein. High levels of M protein in the blood can cause the blood to become too thick. This makes it difficult for the blood to flow to the brain properly and can cause symptoms similar to a stroke, including slurred speech or weakness on one side of your body. Thickened blood can also lead to other neurological symptoms, including:

• Dizziness or feeling disoriented
• Blurry vision
• Headaches

M protein can also damage the nerves in the arms and legs, leading to a condition called peripheral neuropathy (PN). This can cause a “pins and needles” sensation in your limbs, similar to when your foot falls asleep. PN can also cause:

• Weakness in the limbs
• Tingling or burning pain
• A cold feeling in the feet
• Sensitivity to touch
• Difficulty in motor functions like holding items or walking

Although PN can be caused by the disease itself, it may also be a side effect of certain drugs used to treat multiple myeloma. Medications that can cause or worsen PN include:

• Lenalidomide (Revlimid)
• Pomalidomide (Pomalyst)
• Thalidomide (Thalomid)
• Bortezomib (Velcade)
• Ixazomib (Ninlaro)

If you’re experiencing PN, your doctor may consider updating your treatment plan to help improve symptoms. Together, you and your doctor can weigh the risks and benefits of staying on a treatment that’s prolonging remission.

In rare cases, multiple myeloma can cause the spine to become weak and press on spinal nerves. This can create an emergency situation called spinal cord compression. If you notice sudden symptoms like intense back pain or numbness in your legs, seek medical attention immediately.

5. Weakness or Fatigue

Like with platelets and white blood cells, multiple myeloma can also cause low levels of red blood cells, known as anemia. If you have anemia, you might get tired easily, feel weak, or have shortness of breath.

Weakness and fatigue can be caused by many different health problems, including other complications of multiple myeloma. Tell your doctor if you’ve been feeling tired or worn out from everyday activities. They can perform a blood test to look for anemia or other signs of a myeloma relapse.

6. Hypercalcemia

Multiple myeloma can cause hypercalcemia, which is abnormally high calcium levels in the blood. Hypercalcemia can lead to the following symptoms:

• Dehydration or feeling very thirsty
• Digestive problems like nausea, vomiting, or constipation
• Peeing frequently
• Abdominal pain
• Lack of appetite
• Tiredness
• Confusion, delirium

A doctor can order a blood test to measure your calcium levels. If your levels are higher than normal and you have symptoms of hypercalcemia, your doctor may perform additional tests to figure out if you have relapsed multiple myeloma.

7. Kidney Failure

The abnormal M protein made by myeloma cells can build up in the kidneys and prevent them from working properly. This may ultimately lead to kidney failure and bring on a number of symptoms, including:

• Swollen legs or hands
• Weakness or tiredness
• Shortness of breath
• Itchiness

Kidney failure requires immediate medical attention. If you start having any of these symptoms, reach out to your health care provider right away.

Watch Out for Warning Signs

After going through treatment for multiple myeloma, you may feel like mild discomfort isn’t a cause for concern. However, even minor symptoms can be a sign of a relapse. If you’re experiencing new or worsening symptoms or side effects — even if they don’t seem like a big deal — don’t hesitate to reach out to your health care team for a follow-up visit. Your oncologist will ask you about your symptoms and run laboratory tests to look for signs of a possible relapse.

If the cancer cells have come back, your doctor will discuss possible treatment options with you. There are many therapies used to treat relapsed multiple myeloma. Treatment options may include combinations of immunomodulatory drugs — which work by modifying your immune system — and a corticosteroid like dexamethasone.

If you’re eligible, your doctor may recommend a bone marrow transplant to replace myeloma cells in the bone marrow with healthy cells. Additionally, CAR T-cell therapy — an immunotherapy that can modify the body’s immune cells to destroy cancer cells — may be recommended for people with relapsed multiple myeloma.

Read more about targeted immunotherapy for multiple myeloma.

The best treatment option for you will depend, in part, on how you responded to your initial treatment. Your oncologist will review your medical history and come up with a treatment plan to help put your cancer back into remission.

Talk With Others Who Understand

MyMyelomaTeam is the social network for people with multiple myeloma and their loved ones. On MyMyelomaTeam, more than 22,000 members come together to ask questions, give advice, and share their stories with others who understand life with myeloma.

Do you have concerns about a multiple myeloma relapse? Share your thoughts in the comments below, or start a conversation by posting on your Activities page.