The Association Between Multiple Myeloma and Neuropsychiatric Manifestations: A Narrative Review.

[BACKGROUND] Multiple myeloma (MM), a hematologic malignancy, is linked to significant neuropsychiatric comorbidities that negatively impact patient quality of life, treatment adherence, and survival outcomes.

[AIMS] This review aims to explore the potential mechanisms underlying the association between MM and neuropsychiatric manifestations.

[METHODS] This was a narrative review with searches in PubMed/Medline, Google Scholar, and EBSCOhost using keywords related to MM and psychiatric illness. Studies published in English, including preclinical, clinical, observational, case-control, prospective cohort studies, as well as reviews and meta-analyses, were considered.

[RESULTS] Up to 43% of people with MM also suffer from psychiatric comorbidities, and psychiatric illness was shown to be associated with increased mortality rates, reduced quality of life, and higher healthcare costs in MM patients. Our review found that neuropsychiatric manifestations in MM patients are suggested to stem from various factors, including treatment-related effects from steroids and novel BCMA-directed therapies, cancer-induced pro-inflammatory cytokines coupled with systemic inflammation and stress response, direct central nervous system involvement by MM, and psychiatric symptoms resulting from MM complications, including electrolyte imbalances, anemia, infection, and chronic pain.

[CONCLUSIONS] The association between MM and neuropsychiatric manifestations is likely multifactorial. This review underscores the critical need for integrated mental health support within MM management and calls for further research into possible causes such as pathophysiological inflammation, paraneoplastic phenomena related to monoclonal proteins, and prolonged exposure to steroid therapy. Routine neuropsychiatric screening and assessment are imperative for timely identification and intervention to improve overall prognosis in MM patients.