Multiple Myeloma and Anemia

At least 60%-70% of patients with multiple myeloma have anemia at the time they are diagnosed. Learn about symptoms and causes of anemia and how it is managed.

What Is Anemia?

Myeloma cells interfere with the blood-cell-making activities of the bone marrow, often leading to a shortage of red blood cells (RBCs), or anemia. The hemoglobin in RBCs transports oxygen from the lungs to the organs and tissues around the body, and if the body doesn’t receive enough oxygen, the result is exhaustion, shortness of breath, and the inability to carry out the activities of daily living. Anemia is often the first symptom of multiple myeloma.

At least 60%-70% of patients with MM have anemia at the time they are diagnosed, and most will experience it during the course of the disease. If your physician suspects you have anemia, your blood will be drawn for lab tests.

Be sure to report the following symptoms to your physician:

• shortness of breath
• lack of energy and motivation
• rapid heartbeat
• swelling of the legs, especially the ankles
• dizziness
• headache
• chills
• change in appetite
• decreased libido

Causes of Anemia

Anemia may not only be caused by multiple myeloma, but may also be caused by the following:

These treatments are known to cause anemia in a significant number of patients:

• Revlimid®, alone or in combination
• Kyprolis®, alone or in combination
• Pomalyst®, alone or in combination
• Darzalex®, alone or in combination (although not as commonly as the above drugs)

Decreased Kidney Function

• May be the result of myeloma-related free light chain protein blocking the tubules of the kidneys
• May be a pre-existing condition not related to myeloma (for example, the result of diabetes)
• May result in reduced levels of erythropoietin, a hormone released by the kidneys that helps the bone marrow make red blood cells
• May be caused by medications such as:

1. antibiotics taken for a long time and/or at a high dose
2. bisphosphonates (Aredia® and Zometa®) for myeloma-related bone disease
3. NSAIDs (such as Advil®, Motrin®, Naprosyn®) for pain relief
4. some blood pressure medications (diuretics such as Lasix)
5. contrast media given for imaging studies (such as gadolinium used in MRIs)
6. proton pump inhibitors (such as Prilosec®, Prevacid®, Nexium®)
7. some supplements (such as creatine and wormwood oil)
8. laxatives and enemas containing sodium phosphate (such as FLEET® products and MiraLAX®)
9. some medications for diabetes or high cholesterol (discuss with your treating doctor)

Poor Nutrition

• Iron, vitamin B12, and folic acid (folate) are required to produce hemoglobin
• Poor dietary intake is an important cause of low folate and low vitamin B12 levels

Active Bleeding

• Active bleeding that may be the result of hemorrhoids or a low platelet level (thrombocytopenia). Platelets are blood cells that help clot the blood.
• Thrombocytopenia can also be a side effect of treatments for myeloma, including the proteasome inhibitors Velcade®, Kyprolis, and Ninlaro®, and the immunomodulatory drugs Revlimid and Pomalyst.

How Is Anemia Treated?

• Effective treatment of multiple myeloma will treat the related anemia
• If the anemia is a side effect of treatment, your physician may adjust the dose and/or schedule of your therapy
• Blood transfusions can be a temporary solution; eventually patients may become resistant to transfusions of blood from donors
• Erythropoietin (a red blood cell-making treatment such as Procrit® or Epogen®) can be prescribed as long as it is given while you are receiving the anti-myeloma agent that is causing anemia