Multiple myeloma is a B-lymphocyte tumor system (cells carrying immune function).
Multiple myeloma (multiple myeloma) is characterized by degeneration of tumor plasma cells. The disease usually occurs in older people, cases of the disease before the age of 40 years are rare. Men get sick more often.
The causes of the disease are unknown.
Manifestations of multiple myeloma
Myeloma can be asymptomatic for a long time, accompanied by a general increase in the erythrocyte sedimentation rate in blood analysis. In the future, there is a weakness, weight loss, bone pain. Symptoms may be due to bone disease, impaired immunity function, changes in the kidneys, anemia, increased blood viscosity.
Bone pain is the most common sign of myeloma are noted almost 70% of patients. Pain localized to the spine and ribs arise mainly when driving. Ongoing localized pain usually indicate fractures. Bone destruction in myeloma is due to the growth of the tumor clone. Bone destruction results in calcium mobilization from the bones and the development of complications (such as nausea, vomiting, drowsiness, coma). Subsidence vertebrae causes the appearance of symptoms of spinal cord compression. Radiographs reveal any foci of bone destruction or total
osteoporosis.A frequent symptom of multiple myeloma is susceptibility to infections of patients in connection with a reduction in the immune system. Kidney involvement is observed in more than half of patients.
Increased blood viscosity causes neurological symptoms: headache, Fatigue, blurred vision, retinal damage. In some patients the feeling of "pins and needles", numbness, tingling in the hands and feet.
In the initial stage of the disease the blood changes may be absent, but with 70% of patients develop process development increasing anemia associated with bone marrow replacement of tumor cells and tumor myelosuppression factors. Occasionally anemia is the initial and main manifestation of the disease.
A classic feature of multiple myeloma is also sharp and stable increased erythrocyte sedimentation rateSometimes up to 80-90 mm / h. Number of leukocytes and wbc rather, can vary with the expanded picture of the disease is possible to reduce the number of leukocytes (neutrophil), You can sometimes detect the myeloma cells in the blood.
Diagnostics
For cytological bone marrow punctate pattern characterized by the presence of more than 10% plasma (myeloma) cells, a large variety of differing structural features; the most specific to multiple myeloma atypical cell type plazmoblastov.
Classical triad of symptoms of multiple myeloma is bone marrow plasmacytosis (over 10%), serum or urinary M-component, and osteolytic lesions. Diagnosis can be considered reliable in identifying the first two features.
Radiographic changes in bone have an added value. An exception is extramedullary myeloma at which often involved in the process of lymphoid tissue of the nasopharynx and paranasal sinuses.
Treatment of Multiple Myeloma
The choice of treatment and its volume depends on the stage (prevalence) process. In 10% of myeloma patients has been a slow progression of the disease for many years, rarely requiring anticancer therapy. In patients with solitary plasmacytoma lean and extramedullary myeloma effective local radiation therapy. Patients with stage 1A and 11A expectant management is recommended, since some of them can be a slowly progressing form of the disease.
When signs of growing tumor mass (appearance of pain, anemia) should be the appointment of cytostatics. The standard treatment consists of applying
- melphalan (8 mg / m.)
- cyclophosphamide (200 mg / m. in a day),
- chlorambucil (8 mg / m. per day) in combination with prednisolone (25-60 mg / m. per day) for 4-7 days every 4-6 weeks.
The effect of using these drugs nearly the same, cross-resistance may develop. If sensitivity to treatment is usually quickly observed decrease in bone pain, decrease in blood calcium levels, increased hemoglobin in the blood; reduction of serum M-component occurs within 4-6 weeks of starting treatment proportion to the reduction of tumor mass. There is no consensus on the timing of treatment, but usually it is continued for at least 1-2 years, provided effectiveness.
In addition to cytostatic therapy, the treatment is carried out, aimed at the prevention of complications. To reduce and prevent the increased calcium content in the blood is used in combination with glucocorticoid abundant drink. To reduce osteoporosis is prescribed drugs vitamin D, calcium and androgens for the prevention of kidney damage - allopurinol with sufficient drinking regimen. In the case of acute renal failure using plasmapheresis with hemodialysis. plasmapheresis It may be the drug of choice when hyperviscosity syndrome. Severe pain in the bones could be reduced under the influence of radiation therapy.
Forecast
Current treatment prolongs the life of patients with multiple myeloma in an average of 4 years instead of 1-2 years without treatment. The duration of life depends on sensitivity to treatment with cytotoxic agents, patients with primary resistance to treatment have a median survival of less than one year. Prolonged treatment cytostatics frequent cases of acute leukemia (about 2-5%), rare acute leukemia develops in untreated patients.
The life span of the patients depends on the stage at which the tumor is diagnosed. The causes of death may be the progression of myeloma, an honorable failure, sepsis, Some patients die from myocardial infarction, Stroke and other causes.
