Myeloma is a tumor of the B-lymphocyte system (cells that perform the functions of the immune system).
Myeloma (multiple myeloma) is characterized by tumor degeneration of plasma cells. The disease usually occurs in the elderly, cases of the disease before the age of 40 years are rare. Men get sick more often.
The causes of the disease are unknown.
Myeloma can be asymptomatic for a long time, accompanied only by an increase in ESR in the total blood count. In the future, there are weakness, weight loss, pain in the bones. External manifestations may be due to bone damage, impaired immunity, changes in the kidneys, anemia, and increased blood viscosity.
Bone pain is the most common sign of myeloma and occurs in almost 70% of patients. Pain is localized in the spine and ribs, occur mainly during movement. Continuing localized pains usually indicate fractures. The destruction of the bone in myeloma is due to the growth of the tumor clone. The destruction of bones leads to the mobilization of calcium from the bones and the development of complications (nausea, vomiting, drowsiness, coma). The settling of the vertebrae causes the appearance of signs of compression of the spinal cord. On radiographs reveal either foci of bone tissue destruction, or general osteoporosis.
A common sign of multiple myeloma is the susceptibility of patients to infections due to reduced levels of the immune system. Kidney damage is observed in more than half of patients.
Increased blood viscosity causes neurological symptoms: headache , fatigue, blurred vision, retinal damage. Some patients have goosebumps, numbness, tingling in the hands and feet.
In the initial stage of the disease, changes in the blood may be absent, but with the development of the process, 70% of patients develop progressive anemia associated with bone marrow replacement with tumor cells and hematopoietic depression of tumor factors. Sometimes anemia is the initial and main manifestation of the disease.
The classic sign of multiple myeloma is also abrupt and stable. ESR increase , sometimes up to 80–90 mm / h. The number of leukocytes and leukocyte formula they vary greatly, with a developed picture of the disease, a decrease in the number of leukocytes ( neutrophils ) is possible, sometimes in the bloodmyeloma cells can be detected.
The cytological picture of bone marrow punctate is characterized by the presence of more than 10% of plasma ( myeloma ) cells, which are distinguished by a large variety of structural features; Atipic cells of the plasmablast type are most specific for myeloma.
The classic triad of symptoms of myeloma is bone marrow plasmacytosis (more than 10%), serum or urinary M-component and osteolytic damage. The diagnosis can be considered reliable in identifying the first two symptoms.
Radiological changes in bones are of additional importance. The exception is extramedullary myeloma, in which lymphoid tissue of the nasopharynx and paranasal sinuses are often involved in the process.
The choice of treatment and its volume depends on the stage (extent) of the process. In 10% of patients with myeloma, there has been a slow progression of the disease over many years, rarely requiring antitumor therapy. In patients with solitary plasmacytoma lean and extramedullary myeloma effective local radiation therapy. In patients with 1A and 11A stages, a waiting tactic is recommended, since in some of them a slowly developing form of the disease is possible.
With signs of growth of the tumor mass (the appearance of pain, anemia), it is necessary to assign cytostatics. Standard treatment is to apply
- melphalan (8 mg / sq.m. ),
- cyclophosphamide (200 mg / m2 per day),
- Chlorbutin (8 mg / m2 per day) in combination with prednisone (25–60 mg / m2 per day) for 4–7 days every 4–6 weeks.
The effect of using these drugs is about the same, possibly the development of cross-resistance. With sensitivity to treatment, a decrease in bone pain, a decrease in the level of calcium in the blood, an increase in the level of blood hemoglobin; The decrease in the level of the serum M component occurs 4–6 weeks after the start of treatment in proportion to the decrease in the tumor mass. There is no consensus regarding the timing of treatment, but, as a rule, it continues for at least 1-2 years, subject to effectiveness.
In addition to cytostatic therapy, conduct treatment aimed at the prevention of complications. To reduce and prevent increased blood calcium levels, glucocorticoids are used in combination with heavy drinking. Vitamin D, calcium and androgens are prescribed to reduce osteoporosis, and allopurinol is recommended for the prevention of kidney damage with adequate drinking regimen. In case of development acute renal failure use plasmapheresis with hemodialysis. Plasma exchange may be the drug of choice for increased blood viscosity syndrome. Severe pain in the bones can be reduced by radiation therapy.
Modern treatment prolongs the life of myeloma patients on average up to 4 years instead of 1-2 years without treatment. Life expectancy largely depends on sensitivity to treatment with cytotoxic drugs, patients with primary resistance to treatment have an average survival rate of less than a year. With prolonged treatment with cytotoxic drugs, cases of acute leukemia (about 2–5%) are on the increase, rarely acute leukemia develops in untreated patients.
The life expectancy of patients depends on the stage at which the tumor is diagnosed. Causes of death can be progression of myeloma, honorable failure, sepsis, some patients die from myocardial infarction, stroke and other causes.