Can multiple myeloma cause anemia (characterized by decreased Red Blood Cells (RBC), hemoglobin), and a significant increase in inflammatory interleukins?

From the Guidelines

Yes, multiple myeloma can cause a decrease in red blood cells (RBCs) and hemoglobin, as well as an increase in inflammatory interleukins. Multiple myeloma is a cancer of plasma cells that infiltrates the bone marrow, disrupting normal blood cell production. This infiltration directly suppresses erythropoiesis (red blood cell production), leading to anemia characterized by low RBC counts and hemoglobin levels 1. Additionally, the malignant plasma cells produce excessive amounts of inflammatory cytokines, particularly interleukins such as IL-6, IL-1β, and TNF-alpha. These elevated interleukins contribute to the disease's pathophysiology by promoting myeloma cell growth, bone destruction, and further suppression of normal hematopoiesis. The anemia in multiple myeloma can be severe, often requiring treatment with erythropoiesis-stimulating agents or blood transfusions, with guidelines recommending the administration of ESAs at the lowest possible dose to avoid transfusions 1. The cytokine dysregulation also contributes to other symptoms of multiple myeloma, including bone pain, fatigue, and increased susceptibility to infections. Some key points to consider in the management of multiple myeloma-related complications include:

• The use of recombinant human erythropoietin and darbepoetin alfa for the treatment of myeloma-associated anemia 1
• The importance of risk stratification in guiding treatment decisions 1
• The need for prophylaxis and supportive treatment for osteolytic disease, pain, anemia, renal insufficiency, infections, and thromboembolic events 1
• The role of the European Myeloma Network and NCCN guidelines in providing recommendations for the management of multiple myeloma-related complications 1. Overall, the management of multiple myeloma requires a comprehensive approach that takes into account the disease's complex pathophysiology and the need for individualized treatment strategies.

From the Research

Multiple Myeloma and Its Effects on RBC, Hemoglobin, and Inflammatory Interleukins

• Multiple myeloma (MM) is a type of cancer that can cause a decrease in red blood cells (RBC) and hemoglobin levels, leading to anemia 2, 3.
• Anemia is a common complication in patients with MM, occurring in more than two-thirds of all patients, and is often caused by anemia of chronic disease, relative erythropoietin (EPO) deficiency, and myelosuppressive effects of chemotherapy 2.
• Inflammatory cytokines, such as interleukin-1 and tumor necrosis factor, can suppress erythropoiesis, leading to anemia and a decrease in RBC and hemoglobin levels 3.
• The use of erythropoiesis-stimulating agents (ESAs) has been shown to improve anemia in MM patients, increasing hemoglobin levels and reducing the need for blood transfusions 2, 3, 4.
• However, recent studies have raised concerns about the potential risks of ESAs, including an increased risk of thrombosis and a detrimental impact on patient survival 4, 5.

Inflammatory Interleukins and Multiple Myeloma

• Inflammatory interleukins, such as interleukin-1 and tumor necrosis factor, play a role in the development of anemia in MM patients by suppressing erythropoiesis 3.
• The levels of these inflammatory cytokines can be elevated in MM patients, contributing to the development of anemia and other complications 3.
• The use of ESAs can help to improve anemia in MM patients, but the potential risks and benefits of these agents must be carefully considered, taking into account the individual patient's characteristics and etiology of anemia 6.