What are the common symptoms that patients need to be alerted to “multiple myeloma”? The incidence of anemia reaches 70% in patients with initial diagnosis of myeloma, and as the disease progresses, almost all patients eventually become anemic. The main reasons for this are the large number of bone marrow cavities encroached by myeloma cells with suppressed erythropoiesis, impaired renal function, chemotherapy-induced myelosuppression and concomitant bleeding. If anemia is found in the elderly during examination or consultation, it should not be ignored as merely caused by bad teeth and malnutrition, but should be promptly examined by a hematologist to exclude myeloma. Bone pain and back pain in middle-aged and old people are alert to multiple myeloma. Multiple myeloma cells will infiltrate and destroy bone tissue, leading to osteoporosis and even osteolytic bone destruction, and after the bone is destroyed, the sensory nerves in the periosteum will transmit signals to the brain, and people will feel pain. The bone cortex becomes thin or corroded after the bones are destroyed, and the bones become soft and brittle, making it easy for pathological fractures to occur, even with a sneeze. The affected bones may be locally elevated and have an elastic or acoustic sound when pressed. Some elderly people (even young people) fracture their bones with a minor collision, in which case it should not be considered solely due to osteoporosis in the elderly, but to be on the safe side, tests related to the exclusion of myeloma should be performed. Lumbar spine fractures are mostly compression fractures, which can cause nerve root or crestal medullary compression. Therefore, the symptoms of lumbar pain in the elderly should not be ignored only as osteophytes or intervertebral disc disease (some patients even find out that it is myeloma only after surgery), but should be promptly examined to prevent leakage of multiple myeloma. Nausea and vomiting: Multiple myeloma can also occur. A few patients with myeloma may also have nausea and vomiting as their first symptoms and often go to the gastroenterology department, which cannot be ignored. The reason for this is mainly due to the destruction of bone mass in the patient’s body and the release of a large amount of calcium from the bone into the blood, resulting in an increase in blood calcium. If there is also bone pain and anemia, the possibility of multiple myeloma is even greater. 4. Unexplained renal insufficiency: Be alert to renal damage in multiple myeloma The light chain and high blood calcium associated with myeloma can damage the kidneys, and about 40% of patients may show signs of renal damage at the beginning and during the onset of the disease. Renal insufficiency or even uremia may be the first cause of diagnosis in myeloma patients, who may show lumbar acidity, swelling, foamy urine, increased nocturia or decreased urine volume, often going to Nephrology. If patients have no previous history of chronic nephritis, they must be alert to kidney damage secondary to other diseases, of which multiple myeloma is one of the common primary causes. In elderly patients with renal damage along with skeletal pain or anemia that does not parallel renal insufficiency (renal anemia parallels the degree of renal insufficiency), tests related to myeloma should be performed. In addition, because patients with myeloma have reduced normal polyclonal immunoglobulins and neutrophils and are immunocompromised, they are prone to various infections, such as lung infections, urinary tract infections and even sepsis. If patients have recurrent infections within a short period of time, they should think that the immune function of the organism may have problems, and timely routine blood and quantitative immunoglobulin tests may be performed for early diagnosis of multiple myeloma. Previously, the treatment of multiple myeloma was limited, with a treatment efficiency of only about 50%, and the vast majority of patients survived for less than 5 years. Currently, with the application of new drugs, the efficiency of treatment reaches more than 90%, and the survival period is significantly extended, with more than half of the patients having a survival period of more than 5 years, and some patients can even survive with the disease for more than 10 years. Early diagnosis and treatment are the key factors to prolong survival. Therefore, for middle-aged and elderly people with unexplained anemia, weakness, bone pain or fracture, renal insufficiency, nausea and vomiting, or recurrent infections, they should be alert to the possibility of multiple myeloma and seek early hematology consultation.