Multiple Myeloma: The Blood Cancer That Starts in Bone Marrow and the Signs Hematologists Look for First

Multiple Myeloma: The Blood Cancer That Starts in Bone Marrow

Multiple myeloma is a cancer of plasma cells—a type of white blood cell—found in your bone marrow. Normally, plasma cells help fight infection by making antibodies. In multiple myeloma, abnormal plasma cells multiply unchecked, crowding out healthy blood cells and producing faulty proteins that can damage organs.

According to the National Cancer Institute, about 35,000 new cases are diagnosed each year in the U.S. It most often affects people over 60 and is slightly more common in men and in Black individuals. Early detection and treatment can help manage symptoms and improve outcomes.

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How Multiple Myeloma Develops

1. Normal plasma cells mature in the bone marrow and produce antibodies.
2. Abnormal plasma cells (myeloma cells) multiply and form tumors in bone.
3. Myeloma cells crowd out healthy cells, leading to:
   • Low red blood cell counts (anemia)
   • Low normal white blood cells (higher infection risk)
   • Low platelet counts (bleeding/bruising)
4. Faulty proteins (M-proteins) can accumulate in blood and urine, harming kidneys and other organs.

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Who's at Higher Risk?

While anyone can develop multiple myeloma, certain factors raise the chance:

• Age: Most patients are over 60.
• Gender: Slightly more common in men.
• Race: Higher rates in Black individuals.
• Family history: Having a close relative with myeloma or another blood cancer.
• Certain health conditions: Smoldering myeloma or monoclonal gammopathy of undetermined significance (MGUS).
• Environmental exposures: Long-term contact with benzene or radiation.

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Common Signs and Symptoms

Multiple myeloma can progress slowly. Early on, there may be no symptoms. As the disease advances, you might notice:

• Bone pain—often in back, ribs, hips
• Fatigue and weakness—from anemia
• Frequent infections—due to low normal white blood cells
• Excessive thirst and urination—signs of high calcium levels
• Nausea, constipation or loss of appetite—also related to high calcium
• Swelling in legs—from kidney problems or low protein levels
• Bruising or bleeding easily—low platelet counts

Because these symptoms can be caused by many conditions, it's important not to jump to conclusions—but also not to ignore them.

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Early Clues Hematologists Look For

Hematologists (blood cancer specialists) rely on a combination of blood tests, urine tests and imaging to catch multiple myeloma early:

1. Blood tests

   • Complete blood count (CBC) to check red cell, white cell and platelet levels
   • Serum protein electrophoresis (SPEP) to detect M-proteins
   • Free light chain assay for abnormal antibody fragments
   • Calcium, creatinine and other metabolic panels

2. Urine tests

   • 24-hour urine protein electrophoresis (UPEP) to measure M-proteins or Bence-Jones proteins

3. Bone marrow biopsy

   • Samples taken from the hip bone to directly measure abnormal plasma cells (≥10% abnormal cells suggests myeloma)

4. Imaging studies

   • X-rays, MRI, CT or PET scans to identify bone lesions (holes or fractures)

5. CRAB criteria (key diagnostic signs)

   • Calcium (high blood calcium)
   • Renal failure (elevated creatinine)
   • Anemia (low hemoglobin)
   • Bone lesions (on imaging)

Meeting one or more CRAB criteria along with lab evidence usually confirms a diagnosis.

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Why Early Detection Matters

Catching multiple myeloma before extensive bone damage or organ harm has several benefits:

• Treatments can start sooner, slowing disease progression.
• You may avoid serious complications like fractures, kidney failure or severe infections.
• You can better preserve quality of life, pain control and overall function.

That's why any unexplained bone pain, anemia or kidney changes warrant a closer look.

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Next Steps if You Have Concerns

If you experience persistent symptoms—especially bone pain, fatigue or recurrent infections—talk with your doctor about blood and urine tests. To help prepare for your appointment and better understand your symptoms, you can use a free AI-powered Multiple Myeloma (MM) symptom checker that provides personalized insights in just a few minutes.

Remember:

• No online tool can replace a medical exam.
• Only a hematologist can confirm a diagnosis with specialized tests.
• Share any family history of blood cancers or prior MGUS/smoldering myeloma.

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Talking to Your Doctor

Whenever you notice symptoms that could be serious or life-threatening, such as unexplained weight loss, severe bone pain or signs of kidney trouble, make an appointment promptly. Early evaluation by a healthcare provider helps rule out—or catch—conditions like multiple myeloma when they are most treatable.

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Multiple myeloma may sound intimidating, but understanding its early signs and the tests hematologists use can empower you to seek care quickly. If you have any concerns, don't wait—speak to a doctor to get the answers and support you need.