Fatigue in Multiple Myeloma: Is it common and how to manage

Fatigue is very common in multiple myeloma and can come from the disease itself (low healthy blood cells, infections, bone pain) and from treatments such as chemotherapy, targeted drugs, steroids, and bone-strengthening medicines. ^[1] Fatigue is a frequent symptom reported by people with myeloma and is recognized across major cancer centers as a typical side effect of drug therapy. ^{[2] [3]} Bone-modifying agents used in myeloma care (such as zoledronic acid or denosumab) also list tiredness and low energy as expected effects. ^{[4] [5]}

Why fatigue happens

• The cancer reduces healthy blood cells, which can lead to anemia and tiredness. ^[6]
• Immune system changes and recurrent infections can drain energy. ^[2]
• Treatments, including proteasome inhibitors and immunomodulatory drugs, commonly cause asthenic conditions (fatigue, weakness). [PM13] [PM14]
• Bone-strengthening infusions may contribute to flu‑like symptoms and fatigue for some people. [PM15] ^[4]

How common is fatigue across treatments?

• Drug therapy for myeloma frequently includes fatigue among typical side effects noted during care planning at major centers. ^[3]
• Proteasome inhibitors (for example, bortezomib and carfilzomib) report fatigue among the most common toxicities in trials and reviews. [PM13] [PM16] [PM17]
• Immunomodulatory agents (for example, thalidomide) list fatigue and somnolence among key dose‑related adverse effects. [PM14]
• Bone-modifying agents widely used in myeloma care (zoledronic acid, denosumab) include tiredness and lack of energy in patient education materials. ^{[4] [5]}

First steps: check for treatable causes

• Ask your team to check for anemia, thyroid problems, infection, dehydration, sleep apnea, or medication side effects; correcting these can improve energy. ^[3]
• Review steroid schedules (like dexamethasone) and other drugs that may disturb sleep or cause “crash” fatigue; adjustments sometimes help. ^[3]

Evidence‑based management strategies

Activity pacing and gentle exercise

• Light daily activity (such as walking) is encouraged and can improve energy and mood; start slowly and increase as tolerated. ^[7]
• Patient guides for zoledronic acid and denosumab recommend short naps, task prioritization, balanced diet, fluids, and gentle daily exercise. ^{[4] [5]}
• Physical and occupational therapy programs tailored for myeloma can target weakness and fatigue and support independence. ^{[8] [9]}

Sleep and rest hygiene

• Try short, timed naps (about 30–60 minutes) rather than long daytime sleep to avoid worsening night‑time insomnia. ^{[4] [5]}
• Keep a regular sleep schedule, limit caffeine late in the day, and create a calm bedtime routine. ^[7]

Nutrition and hydration

• Aim for a balanced diet with adequate protein and calories; drink fluids unless restricted for kidney reasons. ^[4]
• A registered dietitian can personalize advice during treatment and recovery. ^[3]

Energy conservation and planning

• Prioritize important tasks, break activities into smaller steps, and accept help from others to conserve energy. ^{[4] [5]}
• Use assistive devices or home modifications as recommended by rehabilitation specialists. ^{[8] [9]}

Address mood and stress

• Anxiety and low mood can worsen fatigue; supportive counseling and social work services are available and can help coping. ^[8]
• Peer support groups and reliable education resources reduce uncertainty and mental load. ^[10]

When to contact your care team

• New or rapidly worsening fatigue, dizziness, shortness of breath, palpitations, fever, or signs of infection should prompt timely medical review. ^[2]
• If fatigue is limiting daily activities despite self‑care steps, ask about physical therapy, occupational therapy, and medication adjustments. ^{[8] [7]}
• Report post‑infusion flu‑like symptoms or prolonged tiredness after bone‑strengthening treatments; supportive measures may be advised. [PM15] ^[4]

Practical tips you can start today

• Keep a brief fatigue diary to track patterns with treatments, sleep, activity, and meals. ^[7]
• Schedule demanding tasks at your “best” time of day and pair movement breaks with rest. ^[7]
• Try gentle, low‑impact exercise (walking, stretching, chair yoga) most days, increasing gradually. ^[7]
• Use short naps, hydration, and small, frequent meals to support energy. ^{[4] [5]}

The bottom line

• Fatigue is common in multiple myeloma and its treatments, and it often has multiple causes that can be addressed. ^{[1] [3]}
• A combined approach medical review for reversible causes, gentle exercise, sleep and pacing strategies, nutrition, and rehabilitation usually helps most people feel and function better over time. ^{[7] [8] [9]}