When I started my first job as an OncoPT, I felt immensely prepared to treat all cancer diagnoses.

Just kidding.

I felt very confident treating patients with breast cancer, prostate cancer, & even colorectal cancer, but the diagnoses I was most unprepared for were hematological malignancies.

My new location had a tremendous team of hematology/oncology professionals, so I saw A LOT of these patients very quickly. And multiple myeloma was at the top of the list.

What is multiple myeloma?

Multiple myeloma is a cancer of the B cells and what happens in this case is this proliferation of plasma cells within the bone marrow. Multiple myeloma is actually the second most frequent hematologic hematological malignancies in the United States, second only to Non-Hodgkin Lymphoma.

Multiple myeloma is also the most common primary bone malignancy.

There are significant racial differences among patients with multiple myeloma.

Multiple myeloma primarily affects older individuals, men more often than women, & affects Black Americans more than White Americans.

Multiple myeloma signs & symptoms are CRABby.

A common pneumonic to help remember all of what’s going on with multiple myeloma is called CRAB.

  • C = elevated calcium
  • R = renal failure
  • A = anemia
  • B = bone lesions

One of the earliest signs and symptoms of multiple myeloma is actually this unexplained bone pain. Maybe it presents as low back pain or even bone pain in the extremity long bones, the ribs, the skull, or even the pelvis. Up to 80% of patients already have some kind of bony lesion at the point of diagnosis. 

Pathologic fractures can cause significant pain, mobility, quality of life, & independence problems for the person with multiple myeloma. Unfortunately, pathologic fractures are very common at the point of diagnosis for many patients. Plus, pathologic fractures can also have an increased risk of mortality associated with them.

Some patients may also present with other signs and symptoms of their multiple myeloma, including hypercalcemia-related issues.

Biopsies are not gold standard for diagnosing multiple myeloma.

Because the signs and symptoms of multiple myeloma (aside from a pathological fracture) can be very vague, diagnosis of multiple myeloma may vary person to person. Often patients will undergo an evaluation to rule out other conditions and may undergo different blood &/or urine testing to see if there’s any abnormal levels of M protein.

Some patients may even then undergo a bone marrow aspiration to test their bone marrow for cancerous cells. Other patients will undergo imaging to assess bony lesions. which may include x-rays, CT scans, or even MRI.

Multiple myeloma is staged differently than other cancers.

Since multiple myeloma is not a solid tumor, it is NOT staged using the TNM system.

Multiple myeloma instead follows the International Staging System, which categorizes patients by Stage 1-3 according to specific laboratory parameters.

The higher the stage the less the median survival rate is for patients with multiple myeloma.

For more on multiple myeloma:

So now I want to hear from you: what did I miss? What else would you include in this episode about multiple myeloma? Message me on Instagram and let me know.

Until next time this is Elise with TheOncoPT.  And remember you are exactly the physical therapist that your patients with cancer need. So let’s get to work.


  • Paul KL. Rehabilitation and exercise considerations in hematologic malignancies. Am J Phys Med Rehabil 2011;90(5 Suppl 1)-S88-94.
  • Gerecke C, Fuhrmann S, Strifler S, Schmidt-Hieber M, Einsele H, Knop S. The Diagnosis and Treatment of Multiple Myeloma. Dtsch Arztebl Int. 2016;113(27-28):470-476. doi:10.3238/arztebl.2016.0470
  • Kazandjian D. Multiple myeloma epidemiology and survival: A unique malignancy. Semin Oncol. 2016;43(6):676-681. doi:10.1053/j.seminoncol.2016.11.004