Managing disease complications and treatment side effects

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How myeloma and treatment for myeloma may affect you

The build-up of myeloma cells in the bone marrow can lead to a number of medical problems, or complications, that need to be identified, monitored, and treated. Similarly, treatment for myeloma can cause side effects that require monitoring and/or management themselves.

Bone complications

Throughout our lives, our bones are constantly being remodeled by 2 types of cells with complementary functions:

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Osteoclasts break down old bone to make room for new bone

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Osteoblasts lay down new bone to replace the bone broken down by osteoclasts

Under normal conditions, both types of cells keep the rate of bone formation and bone breakdown equal, so that bone mass remains the same.

Myeloma cells stimulate the osteoclasts (the cells that break down bone) while at the same time interfering with the production of osteoblasts (the bone-forming cells). As a result, bone is broken down faster than it can be replaced, leading to:


areas of damage (or “holes”) in the bone (ie, osteolytic or lytic lesions);


Progressive thinning of the bones (ie, osteoporosis).

Increased risk of fractures

  • Even everyday activities can cause bones to break.

Bone pain

  • Experienced by the majority of myeloma patients.
  • X-rays and bone density scans are used to monitor bone loss and check for damage.
  • Bisphosphonate drugs are routinely prescribed to strengthen the bones.
  • Radiation therapy can be used to treat bone lesions and relieve pain.
  • Procedures can be performed to stabilize fractures of the spine (ie, vertebropasty, kyphoplasty).
Myeloma Bone Disease

Learn more about how myeloma can affect your bones in Myeloma Canada’s Bone InfoGuide.

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Is exercise safe?

Unless there are reasons not to exercise, mild or moderate activity, such as walking or swimming, may be physically and emotionally beneficial. Avoid contact sports or activities that could result in falls. A physiotherapist or your healthcare team may be able to suggest activities that are appropriate for you.

It’s always important to check with your healthcare team before starting any new physical exercise or activity.

Bone pain, nerve pain, and neuropathy

There are 3 main causes of pain for myeloma patients.

The type(s) of treatment required will depend on the cause of the pain, the severity of symptoms, and response to different therapies.

Bone pain

  • Associated with bone damage and fractures.

Nerve damage

  • Often due to compression fractures.

Peripheral neuropathy

  • Usually this occurs in the feet, legs, hands, or arms and can be experienced as:
    • a painful sensitivity to touch
    • the sensation of “electric jolts”
    • a burning, tight, or pulling sensation
    • numbness or a “pins-and-needles” feeling

Treatment options include:

  • pain medication and anti-inflammatories
  • radiation (for bone pain)
  • vertebroplasty or kyphoplasty (for nerve damage due to compression fractures)
  • other types of medication, such as tricyclic antidepressants and anticonvulsant medications (for neuropathic pain)


When high numbers of myeloma cells crowd out red blood cells and decrease their production in the bone marrow, this leads to a reduced red blood cell count. Red blood cells contain hemoglobin which carries oxygen from the lungs to cells throughout the body, providing stamina and energy. A low hemoglobin count can lead to anemia.

Extreme fatigue

  • You feel tired even though you’re getting enough rest.

Shortness of breath

  • You’re out of breath after even mild exertion.

Difficulty concentrating

  • You may find it hard to focus, do daily chores, or remember things.

Other symptoms

  • You may look pale, feel lightheaded or dizzy, experience headaches, have leg pains, or feel cold.
  • If your anemia is related to a change in your diet, eating healthier or taking iron, vitamin B12, or folic acid (folate) supplements may help.
  • In severe cases, blood transfusions can be used to quickly increase hemoglobin in the short term.
  • Your doctor may prescribe medication to stimulate the production of red blood cells.
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IMPORTANT: Always check with your doctor before taking any over-the-counter iron, vitamin, or herbal supplement, as these can interact with prescription medication.

An older Black woman rests on her husband

Why treat anemia?

Studies have shown that treating anemia in people with cancer can help:

  • relieve fatigue
  • make everyday activities easier
  • reduce the need for blood transfusions
  • improve quality of life
  • make it more likely they’ll be able to complete their cancer therapy
Managing Pain & Fatigue

Learn more in the Managing Pain and Fatigue InfoGuide.

Kidney damage

In myeloma, instead of producing antibodies that fight infection and disease, abnormal plasma cells (myeloma cells) overproduce proteins (called monoclonal protein, monoclonal immunoglobulin, or “M” protein). These can cause serious complications and affect different parts of the body including the kidneys.

M-proteins produced by myeloma are cleared from the body by the kidneys, so with time, elevated levels of abnormal M-proteins in the blood and urine can cause damage to the kidneys.

Severe kidney disease may require dialysis (infrequently)

  • The best way to prevent kidney damage is to treat the myeloma and keep the M-proteins as low as possible.
  • Kidney function should be assessed regularly by measuring levels of creatinine in the blood.
  • Drinking lots of fluids, ideally 6–8 glasses of water per day, can help:
    • flush medication and toxins from your body
    • maintain normal blood volume and pressure
    • lubricate your joints
    • reduce fatigue
    • prevent kidney damage
  • Limit your consumption of drinks that contain caffeine (ie, coffee, tea, soft drinks, etc.) and alcohol.
Myeloma and the Kidney

Learn more about how myeloma can affect your kidneys.


Myeloma and some of its treatments can affect the normal production of antibodies and reduce the white blood cell count, making it harder for the body to fight off infections.

Increased susceptibility to infections

  • Repeated infections, especially respiratory infections, or illnesses.

Longer time required to recover from infections or illnesses

  • Fever or signs of infection should be reported promptly to your healthcare team.
  • You can help reduce the risk of infections and illnesses by:
    • practicing good hand-washing techniques
    • washing your hands frequently or using a hand sanitizer
    • avoiding situations that place you in contact with people who are ill
    • wearing a surgical-grade mask when you have to be in a densely crowded environment.
  • Antibiotics may be required before dental work to reduce the risk of infection.

Blood complications

Myeloma can result in blood complications, although they are relatively rare. Potential blood complication include:

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Low platelet levels
– Normal blood clotting is affected, which can lead to bruising or excessive bleeding.

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Increased risk of blood clots in the veins, associated with some medication
– Known as deep vein thrombosis (DVT), a potentially dangerous condition.
– Blood-thinning medication can be prescribed to reduce the risk.

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Thicker-than-normal blood (ie, hyperviscosity) resulting from a high M-protein level.
– Can affect blood flow to the skin, fingers, toes, nose, kidneys, or brain.

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High blood calcium
– As bone is broken down, it releases calcium into the bloodstream. If the myeloma is causing a lot of bone
damage, the levels of calcium in the blood can become excessively high – a condition known as hypercalcemia.


More frequent urination


Confusion (in extreme cases)

If you have myeloma, NEVER take a calcium supplement without checking with your doctor. Too much calcium in the blood can be unhealthy.

Pain medication dependency and addiction

It’s important to work closely with your doctor and healthcare team to find the right pain management strategies for you.

Don’t hesitate to discuss any concerns you may have with your medical team; they can answer your questions and recommend pain relief options that are right for you.

Dental health

Dental health is very important for myeloma patients.

Encourage your dentist to talk to your oncologist, to discuss any special precautions you may require, especially while you are receiving treatment.

Increased risk of infection

Osteonecrosis of the jaw (ONJ)

  • Rare side effect of long-term use of bisphosphonates.
  • Practice good oral hygiene to reduce the odds of needing dental care.
  • See your dentist regularly to catch potential problems when they are small.
  • Get a complete dental examination before starting any therapy.
  • Because myeloma increases the risk of infection, antibiotics may be required before undergoing dental work.
  • Avoid extractions and periodontal surgery, if possible, as well as dental implants.

Possible treatment side effects

In addition to their intended effects, prescription medication may have side effects you may not want.
Ask your healthcare team, particularly your pharmacist and your nurse educator, about:

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potential side effects of the medications you’re prescribed

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which side effects you should report immediately

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what you can do to relieve any side effects you may experience

Managing Pain & Fatigue

Fatigue and pain are common side effects of treatment. Learn more about how to cope with them in the Managing Pain and Fatigue InfoGuide.

Older South Asian man and woman looking at a computer screen

Keep track of any side effects
you may be experiencing in Myeloma Canada’s Myeloma Monitor application

Common side effects of chemotherapy

  • Anti-sickness (anti-emetic) drugs can help prevent nausea and vomiting.
  • Avoid strong smells.
  • Try and get a lot of fresh air.
  • Try to stay hydrated by taking frequent sips of cool drinks.
  • Common with some, but not all, types of chemotherapy.
  • If it happens, remember that your hair will grow back when your treatment is finished.
  • Medicines or special mouthwashes (without alcohol) can help.
  • During high-dose intravenous therapy, sucking on ice chips can help prevent mouth sores.
  • Keep your teeth clean by using a soft toothbrush.
  • Avoid spicy, salty, or tangy foods that can irritate your mouth, as well as foods that stick to the roof of your mouth (ie, peanut butter, chocolate, etc.).
  • Moisten your food with gravy or sauces.
  • To avoid losing weight, try to eat small amounts of food, particularly fresh fruits and vegetables, frequently throughout the day.
  • If you feel hungry at some parts of the day and not at others, eat your larger meal when you’re hungry.
  • No matter what you eat, be sure to always drink plenty of fluids.

More tips on how to maintain a healthy diet during chemotherapy and browse recipes developed specifically for people living with myeloma.

Common side effects of corticosteroids

Steroids are commonly used to treat myeloma, but they can come with their own difficult side effects, including:

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Fluid retention and swelling

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Increase in blood sugar—of concern to people with diabetes or at risk of diabetes

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Increased appetite

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Indigestion or heartburn

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Blurred vision

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Mood or emotional changes, ie, depression, mood swings, agitation, anxiety, or even psychosis

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Long-term use of high-dose steroids can result in:

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Cushingoid appearance (weight gain, with a “moon face”)

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Osteoporosis or bone loss

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Muscle weakness and/or wasting (loss of muscle)

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Other potential side effects

MIddle-aged white woman in lotus pose meditating in the park

It’s important to explore ways to improve your psychological and emotional well-being. Some people find that complementary therapies may help to alleviate or reduce symptoms and side effects.

Always check with your healthcare team before starting or adding any new complementary therapy to your regime.

Coping with “roid rage”

Dealing with a diagnosis of cancer is hard on you and your loved ones. Mood changes that can be brought on by steroids can make things even more challenging.

Be sure to explain to your loved ones how steroids can affect your mood and activity levels. Give them a “heads up” when you go on or off your medication. Chances are they’ll be more supportive and understanding (and won’t take things too personally) if they know that sometimes “it’s the ‘roids talking”… not you!

Multiple Myeloma Caregiver Handbook

Myeloma Canada’s Multiple Myeloma Caregiver Handbook helps caregivers understand and accept their and their loved one’s feelings and needs. It also offers practical advice and strategies on supporting themselves throughout this experience.


40%…that’s the percentage of cancer patients who experience depression or anxiety, according to some studies.

As you go through your journey, there may be times when you feel blue or down, or that you’re no longer the person you used to be. Sometimes, the physical and mental changes you may go through can even take a toll on your self-esteem. This is all completely understandable and normal.

If you experience five (5) or more of the symptoms below for more than two (2) weeks, you should reach out to a health professional:

Symptoms of depression (experienced for more than 2 weeks):

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Feelings of sadness, anxiety, irritability, nervousness, and/or guilt

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Feelings of worthlessness or hopelessness

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Changes in your usual sleep patterns – having trouble sleeping or sleeping more than usual

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Changes in your appetite

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Gaining or losing weight without trying

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Loss of interest in activities you used to enjoy

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Restlessness or slowed behaviour

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Persistent or recurring headaches, digestive disorders, or chronic pain

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Difficulty concentrating, remembering, or making decisions

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Fatigue, loss of energy

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Changes in work style or productivity

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Thoughts of suicide. If you experience suicidal ideation, please seek immediate professional help.

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Depression is real and should not be taken lightly.

Don’t ignore it or try to deal with by yourself. Talk to your healthcare professional, whether it’s your doctor, nurse, or counsellor. Sometimes, just sharing your thoughts and feelings is enough. In other cases, therapy or medication may help.

No matter what, always remember that you’re not alone.

Before considering alternative therapies

…there’s something you should know.

Many vitamins, supplements, and herbal products can interact with your cancer medications.

NEVER take any vitamins, supplement, or herbal therapy without first consulting your physician
and/or your pharmacist.

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Learn more about complementary therapies and how they may help support your well-being during treatment