A new book about Queen Elizabeth II claims she was battling a serious illness the last year of her life. In Elizabeth: An Intimate Portrait, Gyles Brandreth states that Queen Elizabeth had cancer, although her official cause of death was old age. “I had heard that the Queen had a form of myeloma — bone marrow cancer — which would explain her tiredness and weight loss and those ‘mobility issues’ we were often told about during the last year or so of her life,” Brandreth says. “The most common symptom of myeloma is bone pain, especially in the pelvis and lower back, and multiple myeloma is a disease that often affects the elderly. Currently, there is no known cure, but treatment — including medicines to help regulate the immune system and drugs that help prevent the weakening of the bones — can reduce the severity of its symptoms and extend the patient’s survival by months or two to three years.”

So what exactly is myeloma? “Multiple myeloma is a rare blood cancer that affects your plasma cells,” says the Cleveland Clinic. “Plasma cells are white blood cells and part of your immune system. Plasma cells (sometimes called B cells) make antibodies. These antibodies, called immunoglobulins, help fight infection. Multiple myeloma happens when healthy cells turn into abnormal cells that multiply and produce abnormal antibodies called M proteins. This change starts a cascade of medical issues and conditions that can affect your bones, your kidneys and your body’s ability to make healthy red and white blood cells and platelets. Multiple myeloma is rare, affecting about 7 people out of 100,000 people each year. Healthcare providers estimate about 100,000 people in the United States have multiple myeloma.” 

“Cancerous cells leave the bone marrow through the bloodstream, just as normal immune cells leave the bone marrow to help fight off infections,” says Liz Aguiniga, PhD. “The cancerous cells can then travel throughout the body to form more tumors.” Want to know more? Here are five symptoms of myeloma, according to experts. Read on—and to ensure your health and the health of others, don’t miss these Sure Signs You’ve Already Had COVID.

Bone pain is a common symptom of myeloma, doctors say. “We teach the medical students to remember the acronym CRAB,” says Dr. James Hoffman, assistant professor of clinical medicine at the Sylvester Comprehensive Cancer Center, University of Miami Health System. “CRAB stands for the ways that myeloma can hurt people.”

C – High calcium levels (hypercalcemia)

R – Renal (kidney) damage

A – Anemia (low red blood cell count)

B – Bone lesions

“This is a bone marrow illness, so the soft part of the inside of the bones is where the blood cells are born, and that’s where these cancer cells grow,” Dr. Hoffman says. “When the myeloma cells grow within that marrow, they influence the skeletal bone — the hard bone around the marrow — and weaken it.” 

The weakened bones can result in pain, fractures, or broken bones. Having to deal with treatments such as chemotherapy on top of that pain can seem overwhelming. “It can be a really rough and overwhelming experience where you have this symptom that needs to be handled, and at that same time, you need a total body treatment to prevent more problems,” Dr. Hoffman says. “It can be a really rough and overwhelming experience where you have this symptom that needs to be handled, and at that same time, you need a total body treatment to prevent more problems.”

“Bruising is very common,” says Dr. Matt Kalaycio, a board-certified hematologist and a professor at the Cleveland Clinic Lerner College of Medicine at Case Western Reserve University. “The most common reasons that folks with blood cancers bruise is from either medication that thins the blood — like aspirin or anticoagulant drugs — or low platelets. Platelets are the cells that float around in our blood that lend themselves to blood clots. Having too few of them leads to a bleeding risk, and with that comes bruising. So low platelets and anticoagulant medicines to thin the blood to either prevent or to treat blood clots are the most common reasons, but there are other reasons why folks get bruises that are independent of those two mechanisms.6254a4d1642c605c54bf1cab17d50f1e

“If you’re not sure about why there’s a bruise on your arm, your leg, or some other place where you don’t remember having any trauma in that spot — and you’re not on a blood thinner or aspirin — well, sometimes things that look like bruises turn out to be something else. And when we’re talking about blood cancers, the first thing we have to worry about is that it’s part of the blood cancer itself. And so what looks like a bruise isn’t always a bruise, and it’s always a good idea when you’re with your physician to show them the bruises that you have, or send them a picture and let them take a look and make sure that it is, in fact, just an ordinary bruise and not something more ominous.”

Fatigue is one of the most common symptoms of myeloma. “In myeloma, there are three specific causes of fatigue: anemia, cytokines, and pain,” says Scarlett Bergam, MPH. “Any one of these can result in fatigue, along with decreased appetite, weakness, and weight loss. When people experience all three, the resulting exhaustion can be overwhelming.”

Other factors can add to that exhaustion, doctors say. “When someone is diagnosed with cancer — certainly with multiple myeloma — there’s a lot of things that go on all at the same time,” says Dr. Hoffman. “Patients can have pain, patients can have kidney trouble. Patients … will certainly have an extreme amount of anxiety or even depression.” Dr. Hoffman says this is compounded with having to deal with medications, treatments, and costs. “All of this is thrown at the person at the same time. How can a person not be fatigued? What I say to patients when they’re confronted with fatigue is, ‘Let’s fix problems that we can focus on and fix.’ Let’s get the myeloma better,” he said. “Let’s work on anxiety, let’s work on pain, let’s deal with nutrition. As the myeloma gets better, and as you see it get better and feel better about that, fatigue can improve. And it usually does.”

Constant, recurring infections are one of the symptoms of myeloma, experts say. “Abnormal plasma cells cannot protect the body from infections,” says the American Cancer Society. “As mentioned before, normal plasma cells produce antibodies that attack germs. In multiple myeloma, the myeloma cells crowd out the normal plasma cells, so that antibodies to fight the infection can’t be made. The antibody made by the myeloma cells does not help fight infections. That’s because the myeloma cells are just many copies of the same plasma cell – all making copies of the same exact (or monoclonal) antibody.”

“Infection is a major complication and a leading cause of death in patients with multiple myeloma (MM),” say Marcio Nucci, MD, and Elias Anaissie, MD. “The risk of infection is due to a multifactorial immunodeficiency caused by the disease itself and the treatment regimens given during the different phases of therapy. In recent decades, significant progress in the management of MM has occurred, resulting in marked improvement in survival.”

Insomnia and other sleep issues are a common side effect of myeloma. “If you have trouble sleeping while living with myeloma or other types of cancer, you understand the impact it can have on your quality of life,” says Emily Wagner, M.S. “Sleep disorders affect not only your energy levels but also your overall physical and mental well-being. Several studies have shown that between 10 percent and 30 percent of the general population worldwide experience some form of insomnia — and those numbers are higher for people with particular health conditions. 

“Side effects from cancer care treatments can interfere with sleep. Many MyMyelomaTeam members have mentioned “off” sleeping patterns from steroid treatments. One member shared, ‘I usually wake up at 3:30 in the morning and don’t get sleepy until 10:30 to 11:00 in the AM.’ Interestingly, sleep problems and insomnia can be caused by fatigue from the cancer itself. Extreme exhaustion has been shown to interfere with sleep patterns and can cause you to sleep during the day and stay awake at night. This disrupts the body’s natural circadian rhythm and can lead to more health problems down the road.”