Symptoms and Signs of Recurrent or Relapsed Multiple Myeloma

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Signs often emerge before symptoms.

Multiple myeloma is a type of cancer for which symptoms usually do not appear early. That’s unfortunate because symptoms are what motivate people to seek help. It’s important to understand the difference between signs and symptoms.

  • Signs are objective evidence of a medical fact or characteristic. A physician, nurse, or medical/laboratory device detects a sign during the examination of a patient. Examples are blood tests that show chemistry levels and biomarkers. Blood pressure and pulse rates are signs.

  • Symptoms are subjective feelings that a patient experiences and discloses to someone. Others will know about the patient’s symptom only if he or she reveals it. Examples are pain, fatigue, and nausea. Asymptomatic means no symptoms are present.

What are the signs of recurrent multiple myeloma?

Two types of asymptomatic multiple myeloma have signs without symptoms per the National Comprehensive Cancer Network.

1. Smoldering myeloma has M-protein in the blood, increased Bence Jones protein in the urine, 10 percent to 60 percent of abnormal plasma cells in bone marrow.

2.  Active myeloma has at least 10 percent abnormal plasma cells in bone marrow, and one or more of the following signs: increased calcium in the blood, kidney damage, anemia (low red blood cells), or bone damage.

What are the symptoms of recurrent multiple myeloma?

Remember that the symptoms will likely follow the signs. The Multiple Myeloma Foundation lists symptoms as bone pain or fractures, fatigue, increased infections, change in urination, restlessness followed by fatigue, confusion, increased thirst, nausea and vomiting, loss of appetite and weight loss, and compromised kidney function.

If symptoms are silent, how can a recurrence be detected as soon as possible?

A person who is in remission should rely on surveillance by an oncologist every 3 to 6 months. The National Cancer Institute defines surveillance as the use of exams and tests at regular intervals to detect early signs of disease. NCCN guidelines for asymptomatic multiple myeloma recommend the following tests to track changing signs of disease:

  • Complete blood count with differential
  • Blood chemistry tests: BUN, creatinine, calcium
  • Serum quantitative immunoglobulins
  • Serum protein electrophoresis (SPEP) and serum immunofixation electrophoresis (SIFE)
  • Serum free light chain assay as needed
  • 24-hour urine for total protein
  • Urine protein electrophoresis (UPEP) and urine immunofixation electrophoresis (UIFE)
  • Bone survey once a year or more often if symptoms emerge
  • MRI as needed
  • PET/CT as needed
  • Bone marrow aspiration and biopsy as needed
  • Flow cytometry as needed