Multiple myeloma (plasmocytoma, multiple myeloma)

So, myeloma: what is it? How can one understand that a person is developing this particular disease, by what signs can it be recognized at the earliest possible stage?

The essence of myeloma is altered plasma cells. Normally, they do mature from B-lymphocytes in the bone marrow, but their number should not exceed 5%. Anything more related to pathology.

Pathology begins when something interferes with the normal maturation process of a B-lymphocyte, as a result of which it turns into a defective plasma cell.

Myeloma: briefly and succinctly - the essence of the disease

Doctors still cannot accurately determine the causes of the onset of the disease.

It is believed that the “trigger” for the process can be:

bad heredity;
working with toxic substances;
exposure to radiation;
tendency to allergies against one's own tissues;
herpes virus type 8.

Despite this, not a single piece of evidence has yet been presented that at least one of the above list reliably affects the failure in the formation of plasma cells.

When it comes to blood myeloma, we mean one essence of the disease, which has many names:

multiple myeloma;
multiple myeloma;
generalized plasmacytoma;
plasmacytic myeloma.

Despite the multiple names, we are talking about one disease and now we will look at what kind of pathology it is.

Classification

Today it is customary to distinguish several variants of myeloma of bone disease. Depending on how widespread the tumor is, the disease is classified into diffuse, diffuse-focal and focal forms.

Depending on what cells the tumor consists of, it can also be divided into 4 categories. These can be only plasma cells or plasma cells and blasts. There are also polymorphic cell and small cell myeloma.

Depending on what paraproteins these tumors secrete, there are tumors that do not secrete anything, formations that are called diclon, myelomas that are called Bence-Jones and tumors called G-, A-, M-myelomas, which are found more often.

Pathology is usually diagnosed in flat bones. These include the skull, ribs, pelvis, and shoulder blades. On an x-ray, the tumor appears as light spaces that look like holes in bone tissue. Such cavities appear gradually due to lysis and resorption of bone tissue. In addition to the bone marrow and bone tissue, formations may appear in other organs.

Stages of myeloma

This cancer is divided into 3, not four stages.
At the first stage, the disease is completely asymptomatic. It can only be detected by laboratory methods - either suspected by a general blood test, or reliably determined by analysis of material taken during a bone marrow puncture.

The second stage is characterized by a clear expression of clinical symptoms.

At the third stage, which is terminal, the disease begins to spread to other organs.

Symptoms of the disease

Despite the fact that the disease manifests itself deeply individually in each person, there are common signs of myeloma that will help in the early detection of the disease.

If we talk about general symptoms, the patient may complain of:

fatigue;
lethargy;
headache;
labored breathing.

Upon visual examination, such a patient usually has pale skin. In addition, due to decreased immunity, patients diagnosed with myeloma are much more likely to encounter infectious diseases.

Increased bleeding caused by a lack of platelets is another sure sign of myeloma.

The patient may also complain of gastrointestinal disturbances, palpitations and a feeling of heaviness in the hypochondrium. An unstable temperature may also occur: having risen to febrile values, it immediately decreases without the use of any antipyretic drugs.

Please note that all of these symptoms occur at a later stage of the disease. If you are diagnosed with myeloma, there are no symptoms in the early stages. Therefore, the appearance of symptoms should be regarded as a bad sign, indicating that the disease is “gaining momentum” and, quite possibly, will soon enter the terminal stage if intensive therapy does not begin before that time.

Manifestations

Multiple myeloma has its own symptoms and diagnostic signs. The main manifestations of multiple myeloma are numerous pathological fractures of bones that are affected by the pathological process. Symptoms of the disease also include pain along the bones and in soft tissues, decreased hemoglobin levels, increased tendency to bleeding and thrombosis.

Increased blood viscosity leads to the development of other symptoms:

Headache.
Fatigue.
Visual impairment.
Retinal damage.
Numbness in arms and legs.
Tingling in the limbs.

Due to the fact that bones are gradually destroyed during the disease, large amounts of calcium enter the blood. It is deposited in the form of stones in other organs - most often the kidneys, lungs, and gastric mucosa.

Symptoms of the disease also include frequent bacterial infections. This is primarily due to a reduced level of immunoglobulins in the body, as well as due to disturbances that occur during the formation of antibodies.

Most often, the disease goes unnoticed for quite a long time and only at the last stage do the first signs of ill health appear. Basically, at the very beginning, an increased ESR is detected, a little later weakness, weight loss, and bone pain appear. Myeloma of the spine in some cases, without a thorough examination, can be diagnosed as osteochondrosis.

Diagnosis of multiple myeloma

Myeloma can at least be suspected by a blood test for immunoglobulins: IgA, IgM, IgG; They are also paraproteins. If the values are elevated, a sternal puncture of the bone marrow is performed, the contents of which are examined under a microscope.

To diagnose the disease, you can rely on the presence or absence of Bence Jones protein in the urine. This protein is formed from immunoglobulins IgA and IgG. They have a low molecular weight, due to which, if they are in excess in the blood, they can leak through the kidney tubules. It is from these immunoglobulins that the above protein is formed, the presence of which clearly speaks in favor of diagnosing this disease in the patient.

Lytic rib defects detected during a chest x-ray may also prompt the doctor to order more detailed tests to identify (or refute the presence of) myeloma.

If the disease has already been diagnosed, the patient must undergo a blood test for karyotype, during which all possible genetic abnormalities are identified

Diagnostics

Diagnosis of multiple myeloma takes place in oncology centers. A doctor can make this diagnosis based on the results:

Doctor's examination,
Blood tests (general clinical and biochemical),
Complete X-ray examination of the patient’s skeleton,
Bone marrow aspiration biopsy,
Trepanobiopsy of bone marrow.
Immunoelectrophoresis of blood and urine proteins,
Magnetic resonance imaging (MRI),
Computed tomography (CT),
Positron emission tomography (PET),
Bone densitometry.

The doctor, at his discretion, may prescribe additional studies: molecular, cytogenetic and others.

The diagnosis of multiple myeloma is made when:

Increased number of plasma cells in the bone marrow (more than 10%),
Concentrations of M-protein in blood and urine (more than 30 g/dL),
Increased calcium levels in the blood,
Anemia,
Kidney dysfunction
Bone pain.

Myeloma treatment

If a person is diagnosed with myeloma, treatment is what interests him most at the moment. It is adequate therapy that may help the patient get rid of the disease as quickly as possible. It is no coincidence that the word “possible” is used here, since in the terminal stage of the disease any therapy, as a rule, does not make sense. However, everything depends on the individual characteristics of the patient’s body.

It should be borne in mind that therapy is not at all harmless. If the doctor has diagnosed a sluggish course of the disease, in the first stages only medical supervision may be required. If during the next examination an activation of the process is noted, then the doctor will take the next steps and select therapy that is adequate to the current state of the human body.

In any case, treatment tactics are determined by the age and general condition of the patient. So, if the patient is not yet 65 years old, and his course of myeloma is not burdened with concomitant diseases, he may be indicated for aggressive high-dose chemotherapy using a combination of drugs.

Treatment

Treatment of multiple myeloma consists mainly of supportive care with the goal of maintaining a dense bone structure for as long as possible. For pain, analgesics and low doses of radiation therapy are prescribed. However, radiation therapy for multiple myeloma is incompatible with chemotherapy.

Kidney hydration procedures are prescribed to prevent kidney damage. With proper administration, even seriously ill patients can maintain normal kidney function for a long time. Too little fluid can cause severe kidney failure.

Due to decreased immunity, the patient is usually vaccinated against influenza and pneumococcal infection. If the infection is already in the body, antibiotics are prescribed - only in this case, and not for prevention. Also, the risk of complications is significantly reduced when immunoglobulin is administered intravenously.

The disease can be completely cured only by a bone marrow transplant, however, the following types of therapy will help keep the tumor under control for a long time:

radiation therapy;
alpha2-interferon;
cytostatic therapy.

The most common method remains chemotherapy. This is due to the developed groups of drugs that were successfully used together with prednisolone back in the 90s. Polychemotherapy is slightly more effective, although there is no significant difference in survival rates.

There are certain indications for which the doctor prescribes chemotherapy:

complications with infections;
a strong decrease in the level of hemoglobin - a special substance containing iron;
symptoms of kidney pathology;
amyloidosis;
affecting bones;
hypercalcemia (high levels of calcium in the blood serum).

The drug Thalidomide shows good results in treatment. It slows down the development of tumor vessels, restores immunity against cancer cells, and destroys pathological plasma cells. Therefore, prescribing this drug in combination with cytostatic therapy is a good way to avoid a long course of chemicals, which can provoke thrombosis at the point where the catheter is placed.

Unfortunately, bone marrow transplantation for myeloma is not yet very common. The risk of various kinds of complications is too great, and the older the patient, the higher the chance of an unfavorable outcome. Typically, stem cells are transplanted either from the patient himself or from a suitable donor. At the same time, there is a chance that with a transplant of donor material, the disease will be completely defeated.

Complete remission is considered a state when there is no M-protein in the urine and blood serum, which was confirmed by immunoelectrophoresis. Also, no more than 5 percent of pathological cells should be traced in the bone marrow, and new foci have already ceased to appear. Finally, there are no obvious symptoms of the disease.

Folk remedies

The recommendations below are by no means a panacea. Multiple myeloma is a very serious condition; only an oncologist can provide competent assistance. Folk remedies only affect the overall tone of the body, which can help in the fight against the disease.

The healing properties of plants in the fight against cancer have been known for a long time, but these plants are often poisonous, so their extracts are now used in traditional medicine in the form of tablets or injections. As for non-toxic plants, people can take them at home. However, it is better to consult a doctor before doing this.
Swamp cinquefoil. 100 grams of dried root is poured with 1 liter of vodka. Leave in a dark place for 3 weeks, shaking occasionally. The result should be a brownish-colored tincture that is pleasant to the taste and smell. Take 1 tbsp for a month. before meals.
Medicinal sweet clover. Take 1 tbsp. chopped dried herbs, pour 200 ml of boiling water and leave for 60 minutes. After this, be sure to strain. Take 50 ml of drink 3 times a day before meals. The course of treatment lasts two weeks.
Medicinal Veronica. To make an infusion from this plant, you need to brew 1 tsp for 2 hours. dried leaves in 200 ml of boiling water. Drink 70 ml three times a day after meals, about an hour later. Taking it daily for a month will improve your kidney condition.
Elm-leaved meadowsweet. Grind the dried flowers and brew for an hour in a glass of boiling water, drink the infusion 3 times a day, 100 ml. Meadowsweet helps fight tumors, and also reduces pain in the bones and improves kidney function.
Common comfrey. To prepare medicine from this plant, you will need 40 grams of crushed dried root, pour a liter of hot milk, and then steam in the oven for about 7 hours straight, without allowing it to boil. Drink 200 ml three times a day.
Medicinal black root. The remedy from this plant is used externally. Scald the leaves with boiling water, chop and wrap with gauze or bandage. Apply a compress to the sore spot. It relieves pain quite well.
Euphorbia Pallas. Dry and grind 20-30 grams of the root of this plant, pour in 500 ml of vodka. Leave for 14 to 21 days in an unlit place. At first the tincture will be cloudy bluish in color, but then it will turn light yellow. Take 1-2 ml of tincture simultaneously with other medicinal herbs.

Multiple myeloma requires long-term and high-quality treatment. Only by following all the advice of the oncologist can the patient prolong his life as much as possible. It is also advisable to limit yourself in nutrition - eat less food rich in protein. In other words, during exacerbations and intensive treatment, consumption of meat and fish should be avoided.

The most important basic treatment options for multiple myeloma

Before the doctor begins high-dose chemotherapy sessions, the patient undergoes so-called polychemotherapy with ordinary doses.
Then the doctor injects a special drug that provokes the bone marrow to produce its own stem cells. They are taken from the patient and preserved. After this, the patient receives extremely high doses of cytostatic drugs that kill both normal and tumor blood cells. After that, those elements that were preserved are reintroduced to the patient.

What is smoldering multiple myeloma?

TMM is often discovered during unrelated blood or urine tests. TMM is caused by unhealthy plasma cells. Plasma cells are part of the immune system that fights disease. Plasma cells are produced in the bone marrow, which is the spongy tissue inside the bones.

When a person has TMM, their body creates too many plasma cells. These cells are abnormal and create unhealthy antibodies called M proteins.

Typically, antibodies recognize bacteria and viruses that cause disease and prevent them from damaging the body. However, M proteins do not work like normal antibodies because they do not fight disease. Instead, M proteins accumulate in the bone marrow and can cause problems if they reach certain levels. In most cases of TMM, however, there is not enough M protein in the body to cause damage.

TMM usually has no symptoms, so it often goes undiagnosed; however, smoldering multiple myeloma may be discovered during tests that are performed for a separate medical problem.

Rarely, TMM can develop into a type of cancer called multiple myeloma. TMM makes up about 5 percent of all cases of multiple myeloma and is not considered an active form of the disease.

Survival prognosis for multiple myeloma

If a person is diagnosed with bone marrow myeloma, in addition to how to treat it, the patient is interested in the question of survival prognosis.

It is impossible to give a definite answer here. Life expectancy with myeloma is affected by:

patient's age;
presence or absence of concomitant diseases;
tumor response to treatment;
biological characteristics of cells.

The general dependence is as follows: the younger the patient, the earlier treatment of the tumor is started, the greater the chance of being completely cured of this disease. Naturally, this is provided that the course of the disease is not burdened by the presence of other concomitant pathologies in the patient.

Treatment options

Before prescribing treatment for myeloma, of course, the patient’s body is diagnosed. The tactics used by the doctor depend on the research results obtained. If we talk about life expectancy with grade 3 multiple myeloma, the statistics are disappointing (maximum 5 years). But this is not a reason to despair, because now there are many methods and means to support the patient’s body and restore his body.

Attention! Never try to self-medicate in relation to cancer. And even more so, do not use cinquefoil against cancer, myeloma is not a death sentence, consult a doctor for help.

The most effective methods of influence today are:

chemotherapy;
targeted radiation therapy;
drug and antibiotic therapy.

By the way, a properly formulated diet for myeloma can also have a positive effect on the situation.

If we look at chemotherapy in more detail, it is based on such principles as individual selection of drugs and strict adherence to the schedule of procedures. It also ensures a smooth transition from one medicine to another, which is important if the desired result is not achieved.

Treatment of multiple plasma cell cancers can be organized through more serious methods.

Plasmapheresis is a procedure that involves separating blood into separate components. The plasma is cleaned, all components are returned to it, after which the organic liquid is returned back.
Hemosorption is the removal of toxic products from the blood. Special conditions are created for blood contact with the sorbent outside the body, as a result of which it is possible to ensure the regulation of homeostasis.

The above methods help get rid of excess protein, normalize the patient’s condition, and at the same time increase life expectancy in multiple myeloma.

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