Multiple myeloma
A cancer of plasma cells — the antibody-making cells in the bone marrow. It often shows up through its effects, summarised as 'CRAB': raised calcium, kidney impairment, anaemia and bone damage. It is not curable but is very treatable, and treatment has improved greatly.
What it is
Multiple myeloma is a cancer of plasma cells, the type of white blood cell in the bone marrow that normally makes antibodies. In myeloma, one clone of plasma cells multiplies out of control and produces large amounts of a single abnormal antibody (a 'paraprotein' or monoclonal protein), while crowding the bone marrow and disrupting the body in several ways. It typically affects older adults. Rather than one clear symptom, it often reveals itself through a characteristic combination of effects, remembered as CRAB: raised Calcium (from bone breakdown, causing thirst, confusion and constipation), Renal (kidney) impairment, Anaemia (causing tiredness and breathlessness), and Bone problems (bone pain, especially in the back, and fractures from weakened bone). People are also prone to infections. It is diagnosed by finding the abnormal protein in the blood or urine (protein electrophoresis and free light chains), examining the bone marrow, and imaging the bones. Myeloma is not currently curable, but it is very treatable: modern therapies control it well and for long periods, and outcomes have improved substantially.
Key lab markers
- Serum and urine protein electrophoresis, free light chains — detect the abnormal monoclonal protein; central to diagnosis.
- Immunoglobulins (e.g. IgG) — often a high level of one type with low levels of the others.
- Calcium — can be high (from bone breakdown).
- Creatinine / eGFR — kidney impairment is common.
- Full blood count — anaemia is typical.
- Beta-2-microglobulin and albumin — for staging and prognosis.
- Bone imaging and a bone-marrow biopsy — confirm and assess extent.
Symptoms
- Bone pain, especially in the back or ribs; fractures from minor injury
- Tiredness and breathlessness (from anaemia)
- Frequent or recurrent infections
- Symptoms of high calcium — excessive thirst, frequent urination, constipation, confusion
- Kidney problems, sometimes found on blood tests
- Unexplained weight loss
- Often found through the combination of these rather than a single symptom
Related symptoms
Related lab panels
When to discuss with a doctor
Myeloma is often picked up when blood tests, done for tiredness, bone pain or a routine check, show a combination such as anaemia, a raised calcium, kidney impairment or a high total protein — prompting a doctor to look for an abnormal monoclonal protein. Persistent, unexplained bone pain (especially in the back) in an older adult, unexplained fractures, recurrent infections, or the symptoms of a high calcium all warrant assessment. A high total protein or a monoclonal protein found on blood tests should be evaluated. Once diagnosed, myeloma is managed by haematology with treatments that, while not curative, control it effectively and for a long time. Mediora.AI can flag a CRAB-like pattern (calcium, kidney, anaemia) and an immunoglobulin abnormality that together point toward myeloma; the diagnosis and treatment belong with haematology.