Myelosuppression

Myelosuppression, also called bone marrow suppression, is a common challenge for people living with multiple myeloma. It occurs when your bone marrow is affected, slowing or reducing the production of new blood cells — white blood cells, red blood cells, and platelets. Both myeloma and its treatments can contribute to myelosuppression, leading to an increased risk of blood disorders or bleeding.

Understanding myelosuppression in myeloma can help individuals and their care partners take an active role in recognizing and managing these critical changes.

Why Does Myelosuppression Happen in Individuals With Multiple Myeloma?

Myelosuppression in myeloma occurs for two main reasons: the disease itself and the treatments used to control it. Both of these causes affect the bone marrow, leading to myelosuppression.

Myeloma as the Cause

Multiple myeloma is a cancer that develops in the bone marrow, the soft tissue inside bones that produces new blood cells. As myeloma cells grow, they can disrupt normal bone marrow function. This myeloma bone marrow suppression reduces the production of red blood cells, white blood cells, and platelets.

Treatments as the Cause

In addition to the disease, many treatments for multiple myeloma, such as chemotherapy and CAR T-cell immunotherapy, can cause bone marrow suppression. These medications slow the growth of cancerous cells, but they may also damage bone marrow tissue, reducing its ability to produce healthy blood cells. For this reason, myelosuppression is a common concern throughout myeloma treatment.

Effects of Myelosuppression on Blood Counts

Myelosuppression often leads to a drop in all the major types of blood cells due to the decrease in production. Blood-count suppression caused by myeloma can result in several medical complications, including neutropenia, anemia, and thrombocytopenia. 

Anemia

Anemia occurs when the bone marrow doesn’t produce enough red blood cells, which are responsible for carrying oxygen throughout the body. The condition is common in myeloma, affecting 60% to 70% of individuals at the time of diagnosis. It is monitored by measuring hemoglobin levels — low levels indicate anemia.

Common symptoms of anemia include:

• Fatigue and weakness
• Shortness of breath
• Brain fog and headaches
• Tachycardia or arrhythmias
• Dizziness or lightheadedness

Since anemia is common in myeloma, monitoring and addressing it is an important part of overall care.

Neutropenia

Neutropenia is a decrease in the number of neutrophils, a type of white blood cell essential for fighting off fungal and bacterial illnesses. They are the first cells to arrive at the site of an infection. Thus, the most significant concern with neutropenia is the risk of infection.

Signs of infection to watch for include:

• Fever or chills
• Sore throat or mouth sores
• Cough or difficulty breathing
• Dizziness and fainting
   

Doctors may adjust treatment plans based on the risk of neutropenia, so promptly reporting signs of infection is crucial.

Thrombocytopenia

Thrombocytopenia is a condition in which the body has a lower-than-normal number of platelets — tiny, colorless blood cells that help stop bleeding by forming clots. This condition affects around 20% of newly diagnosed multiple myeloma patients. It is often a side effect of treatment with proteasome inhibitors such as VELCADE® (bortezomib), KYPROLIS® (carfilzomib), and NINLARO® (ixazomib) and XPO1 inhibitors such as XPOVIO® (selinexor).

Symptoms to watch for include:

• Bruising
• Pink urine
• Nosebleeds
• Small red or purple spots on the body (petechiae)
• Bleeding that does not stop with pressure

Careful monitoring for these symptoms is vital, as even minor injuries can be more serious when platelet counts are low.

Monitoring and Managing Myelosuppression

Since myelosuppression is a common concern in multiple myeloma, your healthcare team will monitor your blood counts regularly through a Complete Blood Count (CBC) test. This simple blood test checks your red blood cell, white blood cell, and platelet counts, making it easier to spot early suppression of blood counts.

If you develop low blood counts, your care team may recommend different management strategies, such as:

• Adjusting your myeloma treatments: Your doctor may lower the dose, switch medications, or change the treatment schedule to minimize bone marrow suppression.
• Administering growth factors: A healthcare provider can inject you with medications such as granulocyte colony-stimulating factors (G-CSF), which can stimulate the production of white blood cells (neutrophils).
• Receiving transfusions: If your red blood cell or platelet counts become very low, you may receive blood or platelet transfusions to reduce symptoms and prevent complications.
• Preventing infection and bleeding: Your team will talk with you about ways to avoid infections and injuries, including practical steps such as handwashing, avoiding crowds, and taking prescribed antibiotics.

When to Contact Your Care Team

It’s important to contact your care team right away if you notice any symptoms that could indicate low blood counts or an infection. Early action can help prevent serious complications associated with myelosuppression in myeloma. If you are unsure if a symptom is serious, it is always better to reach out to your providers.

Some questions you can ask your care team include:

• How will you monitor and address myelosuppression if it occurs?
• Which of my symptoms might be related to myelosuppression?
• What signs of infection or bleeding should I watch for at home?
• How will myelosuppression affect my current treatment plan?
• Are there lifestyle changes (diet, activity) I should consider?

Working with your healthcare team, you can monitor for signs of myelosuppression, address problems early, and adjust your care so you stay as healthy as possible during myeloma treatment.

Find Support So You Can Live Well With Myeloma 

You’re not alone in navigating the experience of myeloma. At the International Myeloma Foundation (IMF), we offer trusted resources and support at every step. If you have questions or need personalized help, contact us at 1-800-452-CURE (2873) or interact with Myelo, our generative AI chatbot, for guidance and information tailored to your needs.