Myeloma: causes, signs, stages, life expectancy, therapy

Myeloma belongs to the group of paraproteinemic hemoblastoses, in which malignant transformation of plasma cells is accompanied by their hyperproduction of abnormal immunoglobulin proteins. The disease is relatively rare; on average, 4 people per 100 thousand people become ill. It is believed that men and women are equally susceptible to the tumor, but, according to some data, women still get the disease more often. In addition, there are indications of a greater risk of myeloma among black populations in Africa and the United States.

The average age of patients ranges between 50 and 70 years, that is, the majority of patients are elderly people who, in addition to myeloma, have other pathologies of internal organs, which significantly worsens the prognosis and limits the use of aggressive methods of therapy.

Myeloma is a malignant tumor, but it is a mistake to call it “cancer”, because it does not originate from the epithelium, but from hematopoietic tissue. The tumor grows in the bone marrow, and its basis is made up of plasma cells. Normally, these cells are responsible for immunity and the formation of immunoglobulins necessary to fight various infectious agents. Plasmocytes are derived from B lymphocytes. When cell maturation is disrupted, a tumor clone appears, which gives rise to myeloma.

Under the influence of unfavorable factors in the bone marrow, there is an increased proliferation of plasmablasts and plasmacytes, which acquire the ability to synthesize abnormal proteins - paraproteins. These proteins are considered immunoglobulins, but they are not capable of performing their direct protective functions, and their increased quantity leads to thickening of the blood and damage to internal organs.

The role of various biologically active substances has been proven, in particular interleukin-6, which is elevated in patients. Bone marrow stromal cells, which perform a supporting and nutritional function (fibroblasts, macrophages), secrete interleukin-6 in large quantities, as a result of which tumor cells actively multiply, their natural death (apoptosis) is inhibited, and the tumor actively grows.

Other interleukins can activate osteoclasts, cells that destroy bone tissue, which is why bone lesions are so characteristic of myeloma. Being under the influence of interleukins, myeloma cells acquire an advantage over healthy ones, displacing them and other hematopoietic germs, leading to anemia, immunity disorders, and bleeding.

The course of the disease is conventionally divided into chronic and acute stages.

• In the chronic stage, myeloma cells do not tend to multiply quickly, and the tumor does not leave the bone, patients feel satisfactory, and sometimes are not aware of the onset of tumor growth.
• As myeloma progresses, additional mutations of tumor cells occur, resulting in the emergence of new groups of plasma cells capable of rapid and active division; the tumor extends beyond the bone and begins its active spread throughout the body. Damage to internal organs and inhibition of hematopoietic germs lead to severe symptoms of intoxication, anemia, and immunodeficiency, which make the acute stage of the disease terminal, which can lead to the death of the patient.

The main disorders in myeloma are bone pathology, immunodeficiency and changes associated with the synthesis of a large number of abnormal immunoglobulins. The tumor affects the pelvic bones, ribs, and spine, where tissue destruction occurs. Involvement of the kidneys can lead to chronic kidney failure, which is quite common in patients suffering from myeloma.

Cause of myeloma

Myeloma consists of altered plasma cells. In normal bone marrow, plasma cells are born from B lymphocytes, but their number is limited to only 5%; a larger number is already pathological.

There is no certain clarity about the root cause of the development of a plasma tumor; poor heredity and a tendency to allergies against one’s own tissues, radiation and work with toxic substances are suspected of initiating the process; herpes virus type 8 has also come under suspicion.

True, reliable evidence of the participation of all of the above in malignant degeneration has not been presented. One thing is clear, something prevented the normal maturation of B lymphocytes or interfered with the multi-stage path from their “childhood” to lymphatic maturity, because of something the lymphocyte turned into a defective plasma cell, which gave rise to myeloma.

Multiple myeloma affects three out of 100 thousand Russians, usually elderly people - mainly in the seventh decade of life; in young people under 40 years of age, the disease is very rare.

Among those suffering from diseases of the blood and lymphatic tissue, 10-13% have plasmacytoma, but of all malignant processes existing in nature, patients with plasma cell tumors account for no more than one percent.

Types of multiple myeloma

There are several classifications of myeloma. According to the degree of prevalence of tumor lesions, they are distinguished:

• Diffuse form of multiple myeloma. Bone marrow infiltration occurs without bone destruction (osteodestruction).
• Diffuse focal form of myeloma. In addition to bone marrow infiltration, there are foci of bone destruction.
• Multiple focal form of myeloma. There are foci of osteodestruction, but there is no diffuse damage to the bone marrow. In this case, when examining the punctate, it is possible to obtain a normal myelogram.
• Rare forms of myeloma - sclerotic, visceral, etc.

Multiple myeloma is also classified based on the immunochemical type of the tumor. The main factor here is the type of pathological immunoglobulin detected in the blood and urine. There are G, A, D, E, M-myeloma, Bence Jones myeloma, biclonal and non-secreting.

What happens with myeloma?

For some reason, abnormal cells appear in the bone marrow, multiplying and disrupting normal hematopoiesis, which is manifested by anemia. The lack of red blood cells affects the functioning of all organs, but especially strongly on the lung tissue and brain, which is manifested by a lack of their functions.

The function of normal plasma cells is to produce immunoglobulin antibodies to protect against pathogenic agents. Myeloma plasma cells also produce immunoglobulins, but defective paraproteins that are not capable of immune defense.

Paraproteins produced by malignant plasma cells are deposited in organ tissues; the favorite “storage site” is the kidneys, in which “light chain disease” develops, resulting in renal failure. In the affected liver, the production of blood-thinning substances decreases - blood viscosity increases, disrupting metabolic processes in tissues, and blood clots form. Deposits of immunoglobulins cause damage to other organs, but are not so fatal.

In bones, myeloma cells stimulate osteoclasts, causing osteolysis—the erosion of bone. From the destroyed bone, calcium enters the plasma, accumulating, leading to hypercalcemia - a serious condition that requires urgent measures.

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Stages and prognosis for multiple myeloma

Staging of multiple myeloma is determined based on 4 parameters: the amount of M component, hemoglobin level, calcium level, and the degree of bone damage. Stages:

• Stage 1 myeloma - mild anemia (hemoglobin more than 100 g/l), normal calcium, low M-protein, less than 5 bone lesions. The average life expectancy of such patients is 6.5 years.
• Stage 2 of myeloma - moderate anemia, calcium increased to 3 mmol/l, the number of osteolysis foci does not exceed 20, M-component level: 35 IgG < 35-70 g/l IgM 30-50, Bence-Jones proteinuria 4-12 g /day.
• The third stage of myeloma is diagnosed in the presence of at least one of the following signs - severe anemia (hemoglobin below 85 g/l), calcium above 3 mmol/l, high level of M-protein, severe osteodestruction (more than 30 foci of osteolysis - bone destruction). The average life expectancy is 2 years.

In addition, there is a myeloma staging system based on the level of B2-microglobulin and albumin in the blood:

• Stage 1 of multiple myeloma - B2-microglobulin below 3.5 mg/l, albumin above 35 g/l.
• Stage 2 myeloma - B2-microglobulin increases to 5.5 mg/l, albumin decreases below 35 g/l.
• Stage 3 myeloma - B2-microglobulin values ​​exceed 5.5 mg/l.

Diagnosis of multiple myeloma

The diagnosis is made by blood tests, where paraproteins are found and their total and type concentrations are determined. Paraproteins are designated as immunoglobulins - IgA, IgG and IgM. Plasmocytes produce immunoglobulins at their own discretion and in varying quantities; their changes in the production of pathological proteins subsequently assess the effectiveness of treatment and disease activity.

The degree of aggressiveness of plasma cells is determined by microscopy of the bone marrow; it is obtained from the sternum during a sternal puncture or during a biopsy of the pelvic bone. The study is especially relevant when the production of paraproteins is low or when the nature of the course of the disease changes.

A long-standing marker of the disease is Bence Jones protein in the urine, detected in 70% of patients. The protein is formed from chains of small molecular weight immunoglobulins A and G—“lungs”—that leak out of the kidney tubules. The Bence-Jones content also controls the course of the disease.

Often the disease is accidentally discovered during a routine chest x-ray based on lytic defects of the ribs. At the first stage, it is necessary to identify all destructive changes in the bones in order to further monitor the process and results of therapy, which is possible with highly sensitive low-dose CT of the entire skeleton.

MRI examines the condition of the flat bones - the skull and pelvis, which is necessary for smoldering and solitary tumors. MRI helps to evaluate not only bone defects, but also the presence of tumor infiltration of soft tissues and involvement of the spinal cord in the process.

A karyotype analysis is required to identify genetic abnormalities that affect the patient’s prognosis and the effectiveness of treatment.

Diagnosis of the disease

To determine multiple myeloma, diagnosis must include visual, instrumental and laboratory research methods.

During the examination, the surgeon or oncologist asks the patient about complaints and the time of onset of unpleasant symptoms, measure the pulse rate, palpate the painful areas of the bones, recording whether the pain intensifies when pressed. The color of the skin is also assessed (pallor may indicate anemia), the presence of bruises and bruises, and swelling in places where the tumor is often localized. If myelomatosis is suspected, the patient is prescribed a series of tests.

The list of hardware diagnostic methods that are used to detect myelomas includes:

• X-ray examination of the bones of the skeleton and chest;
• Magnetic resonance imaging;
• spiral computed tomography.

All three methods make it possible to identify areas of reduced bone tissue density and differentiate the pathology from other diseases of the musculoskeletal system. When affected by multiple myeloma, it is clearly noticeable on the x-ray that the bones of the skull, spine, shoulder blades and limbs are dotted with dark spots of osteolytic damage. With a solitary (single) tumor, a violation of density is observed only at the site of its localization.

Tomography is a more informative and complete method. It allows you to track bone lesions of the entire musculoskeletal system in a short time and without irradiating individual parts of the body.

Instrumental diagnostics include taking a sample (puncture) of the bone marrow to compile a myelogram. A myelogram is the result of an analysis of biomaterial (myeloid tissue), which indicates the qualitative and quantitative composition of the bone marrow.

This study makes it possible to differentiate the disease from other types of blood cancer. The main diagnostic symptom of myeloma is a pathologically increased proportion of plasma cells (more than 10-30% when the norm is up to 1.5%). In parallel with plasma cells, the content of undifferentiated blasts may increase (the norm is up to 1.1%).

The content of erythroblasts, lymphocytes and other hematopoietic cells, on the contrary, is significantly reduced.

When the diagnosis of myeloma is beyond doubt

The characteristic features of the cells determine the course of the process from a slow and almost benign gammopathy or smoldering myeloma to rapid plasma cell leukemia.

It is not always possible to initially classify the disease, which complicates the choice of optimal therapy. In 2019, an international consensus defined criteria that facilitate accurate diagnosis and separate one type of tumor process from others.

First of all, the percentage of plasma cells in the bone marrow is determined, so in case of symptomatic myeloma there should be more than 10%, and 60% indicates a high aggressiveness of the tumor.

For each variant of the disease, certain quantitative characteristics and combinations of criteria are provided, so to be completely sure that a patient has myeloma, it is necessary to detect specific “products”:

• M-protein in the blood, that is, IgA or IgG;
• immunoglobulin light chains;
• Bence Jones protein in urine;
• lesions in the bones of the skeleton.

If specific criteria are insufficient, diagnosis is helped by nonspecific, but often occurring effects of the activity of plasma cells and paraproteins on target organs:

• increased blood calcium levels as a result of massive bone destruction;
• decrease in hemoglobin due to tumor replacement of the bone marrow;
• increased blood creatinine, a marker of renal failure.

Classification of myelomas and their diagnosis

Myelomas are classified depending on the location of altered plasma cells in healthy bone marrow tissues and the specifics of their composition. Depending on the localization of pathological cells in hematopoietic tissues, diffuse, diffuse-focal and multiple (multifocal) forms of the disease are distinguished.

The composition of the cells makes it possible to classify myelomatous tumors into plasmablastic, plasmacytic, small- and polymorphic cell. The type of atypical plasma cells is determined by tissue (histological) examination. This characteristic allows one to predict the rate of tumor growth.

One of the classifications common in medical practice also takes into account the peculiarities of the localization of the pathological focus (foci) in the skeletal system and internal organs.

Solitary or solitary myelomatous tumors are located in the bone containing bone marrow tissue or in the lymph node. Lymph nodes are directly involved in the immune response to infectious agents, and therefore are often affected by multiple myeloma.

Multiple foci of myelomatosis occupy several places at once. The bone marrow tissue of the spine, iliac and cranial bones, shoulder blades, and ribs is especially vulnerable to mutated plasma cells. Often, tumor foci form in the spleen, several lymph nodes and the central part of the tubular bones of the legs and arms.

If multiple myeloma is suspected, as well as relapse of solitary plasma cell neoplasia, a full body examination is performed using tomography.

Myeloma symptoms

It has been noted that each pool of plasma cells produces immunoglobulins with personal characteristics and according to its own schedule, which is why the clinical manifestations are very unique and deeply individual. No two patients are alike, and it is even more impossible to find two similar patients based on diagnostic criteria. However, there are several types of the disease. According to the number of lesions, the tumor can be generalized or multiple and solitary - with a single focus.

According to the course, a distinction is made between sluggish or smoldering, also known as indolet, and symptomatic plasmacytoma, which occurs with obvious clinical manifestations.

The main manifestation of symptomatic myeloma is pain in the bones due to their destruction, which does not appear immediately and often not even in the first year of the disease. Pain syndrome occurs when the periosteum, penetrated by nerve endings, is involved in the tumor process. With a slow process, several years may pass before the tumor is identified, since the patient experiences nothing but episodes of weakness.

In the advanced stage with multiple lesions, fractures in places of bone destruction and manifestations of renal failure, or amyloidosis of organs, come to the fore in different combinations and with individual intensity.

Symptoms of the disease

In the presence of myeloma, damage to the bones and kidneys occurs first, which causes disturbances in the hematopoietic system. Symptoms of myeloma depend on the stage of its development, as well as the extent of the damage. Since the development of the disease takes a very long time, its asymptomatic course can last about fifteen years. At this time, the patient will not even suspect the presence of a serious pathology. It is possible to detect myeloma through laboratory tests for preventive examination or treatment of other pathologies.

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Symptoms of myeloma include the following:

• frequent dizziness;
• anemia develops;
• presence of pain;
• asthenia;
• rapid decrease in the patient's weight;
• constant acute respiratory viral infections and acute respiratory infections.

If these signs of multiple myeloma appear, you should immediately consult a specialist and undergo additional examination to recognize the pathology.

With extensive spread of multiple myeloma, patients often experience the following syndromes:

• Pathological damage to bones - during myeloma, bone tissue is immediately damaged, because it is in them that the primary foci of oncopathology arise. As the tumor progresses, severe pain, frequent bone fractures and soft tissue tumors appear. After some time, the bone in the affected area is destroyed, and secondary foci of destruction appear. The patient develops osteoporosis.
• Disturbances in the functioning of the circulatory system - the patient gradually develops anemia, accompanied by pale skin, breathing problems and increasing weakness. Neutrophils and platelets begin to be produced in smaller quantities, which leads to the development of hemorrhagic syndrome.
• Protein pathology syndrome - occurs due to excessive production of pathological proteins. Large amounts of paraprotein can be found in urine and internal organs. Headaches occur, vision deteriorates, and trophic ulcers occur.
• “Myeloma kidney” syndrome - approximately 80% of patients experience kidney damage in myeloma, which is due to the appearance of plasma cells and calcification deposits in them. Thus, as myeloma progresses, kidney problems occur.

Even as the disease develops, the central nervous system is affected and hypercalcemia begins, this only complicates the course of the disease. When the pathology reaches the final stage, the clinical symptoms increase significantly. In some cases, acute leukemia develops at the fourth stage.

Treatment of multiple myeloma in young people

The indolent variant of myeloma does not always require treatment, since it is not life-threatening, and the therapy is not at all harmless. In this case, monitoring the process is more beneficial to the patient than toxic chemotherapy. Regular examinations allow timely diagnosis of the activation of the process.

Symptomatic myeloma is divided into stages from I to III according to the level of specific microglobulin and albumin in the blood; the strategy for stages I and II-III differs only in the drugs used and their combinations.

At any stage, the main thing that determines the tactics is the patient’s condition and his age. Thus, healthy patients up to 65 years of age and without severe chronic diseases are offered aggressive high-dose chemotherapy with transplantation of their own blood stem cells, scientifically called autologous transplantation.

Physically intact patients from 65 to 70 years of age can also qualify for high-dose chemotherapy, but not with a combination of drugs, but with a single drug - melphalan.

Before high-dose chemotherapy begins, several courses of polychemotherapy are carried out at normal doses, then a special drug is used to stimulate the bone marrow to produce its own stem cells, which are collected and preserved. Then the patient receives very high doses of cytostatics, as a result of which all blood cells - tumor and normal - die. Normal, pre-preserved blood elements are administered to the patient.

Treatment of the disease

After conducting the diagnosis and studying all the results of the study, the doctor chooses a treatment method, which depends on the stage of development of the disease, the general condition of the patient, and the aggressiveness of the malignant process. The main methods of getting rid of the disease include:

• Polychemotherapy is chemotherapy using several medications.
• Hormonal therapy will help enhance the effect of the main treatment (chemotherapy).
• Strengthening the immune system with immunotherapy will help improve overall health and prolong remission time.
• Radiation therapy is aimed at irradiating tumors, which helps reduce their size and prevent their growth.
• Plasmapheresis is an active effect on pathologically altered plasma cells.
• Performing surgery to remove large malignant tumors that put pressure on blood vessels, disrupting normal blood circulation, or negatively affect nerve endings. In addition, surgery is also effective if there is a small number of malignant tumors (in the early stages), which can be removed and provide a long period of remission.
• The most effective method of curing the disease is a bone marrow transplant, but it is extremely difficult to find a suitable donor and the procedure is very expensive. This technique will completely cure the patient and avoid relapse in the future.

Additionally, medications are used to relieve symptoms:

• Painkillers (Ibuprofen, Spazmalgon, and in a particularly advanced form, Morphine, Omnopon).
• Normalizing calcium metabolism (Calcitonin, Prednisolone, Sodium Ibandronate).
• Eliminating renal failure (Hofitol, Prazosin, Retabolil).

Treatment of myeloma in the elderly

Patients over 65 years of age and younger, but with concomitant diseases that affect their general condition and activity, also undergo cyclic chemotherapy at the first stage, including the use of targeted drugs. The result of treatment is assessed by blood and bone marrow tests, where the concentration of disease-specific proteins and the percentage of tumor cells are determined. The result of treatment is affected not only by age, but also by the presence of several chronic diseases, asthenia, which implies physical weakening with or without weight loss.

Our ancestors called an asthenized person “kvely”. Such patients run the risk of not being able to tolerate aggressive treatment, but respond quite well to milder options for antitumor chemotherapy.

In recent years, the range of chemotherapy drugs has expanded significantly to include targeted agents that have demonstrated good immediate results and increased life expectancy in study participants.

Skeletal lesions are subject to long-term therapy with bisphosphonates, which reduce pain, prevent fractures and hypercalcemia. Individual tumor foci are exposed to ionizing radiation; radiation therapy is required if there is a threat of compression of the spinal cord and damage to the cervical spine.

Treatment

Treatment of myeloma is carried out by a hematologist in a hematology hospital and includes:

• Cytostatic therapy.
• Radiation therapy.
• Prescription of alpha2-interferon.
• Treatment and prevention of complications.
• Bone marrow transplantation.

Multiple myeloma is considered an incurable tumor of the hematopoietic tissue, but timely therapy can make the tumor controllable. It is believed that a cure is possible only with a successful bone marrow transplant.

Today, chemotherapy remains the main method of treating myeloma, allowing to prolong the life of patients up to 3.5-4 years. The successes of chemotherapy are associated with the development of a group of alkylating chemotherapy drugs (alkeran, cyclophosphamide), which have been used in combination with prednisolone since the middle of the last century. Polychemotherapy is more effective, but patient survival does not increase significantly. The development of tumor chemoresistance to these drugs leads to a malignant course of the disease, and to combat this phenomenon, fundamentally new drugs have been synthesized - apoptosis inducers, proteasome inhibitors (bortezomib) and immunomodulators.

A wait-and-see approach is acceptable in patients with stages IA and IIA of the disease without pain and the risk of bone fractures, subject to constant monitoring of blood composition, but in case of signs of tumor progression, cytostatics are mandatory.

Indications for chemotherapy are:

1. Hypercalcemia (increased serum calcium concentration);
2. Anemia;
3. Signs of kidney damage;
4. Bone involvement;
5. Development of hyperviscous and hemorrhagic syndromes;
6. Amyloidosis;
7. Infectious complications.

The main treatment regimen for myeloma is a combination of alkeran (melphalan) and prednisolone (M+P), which inhibit the proliferation of tumor cells and reduce the production of paraproteins. In the case of resistant tumors, as well as an initially severe malignant course of the disease, polychemotherapy is possible, when vincristine, adriablastine, and doxorubicin are additionally prescribed in accordance with the developed polychemotherapy protocols. The M+P regimen is prescribed in cycles every 4 weeks, and if signs of renal failure appear, alkeran is replaced with cyclophosphamide.

The specific program of cytostatic treatment is chosen by the doctor, based on the characteristics of the course of the disease, the condition and age of the patient, and the sensitivity of the tumor to certain drugs.

The effectiveness of the treatment is evidenced by:

• Stable or increasing hemoglobin level (not lower than 90 g/l);
• Serum albumin over 30 g/l;
• Normal level of calcium in the blood;
• No progression of bone destruction.

The use of a drug such as thalidomide shows good results in myeloma, especially in resistant forms. Thalidomide inhibits angiogenesis (development of tumor vessels), enhances the immune response against tumor cells, and provokes the death of malignant plasma cells. The combination of thalidomide with standard cytostatic therapy regimens gives a good effect and allows, in some cases, to avoid long-term administration of chemotherapy, which is fraught with thrombosis at the site of the venous catheter. In addition to thalidomide, a drug made from shark cartilage (neovastal), which is also prescribed for multiple myeloma, can prevent angiogenesis in the tumor.

For patients under 55-60 years of age, it is considered optimal to undergo polychemotherapy followed by transplantation of their own peripheral stem cells. This approach increases the average life expectancy to five years, and complete remission is possible in 20% of patients.

Alpha2-interferon is prescribed in high doses when the patient enters a state of remission and serves as a component of maintenance therapy for several years.

Video: lecture on the treatment of multiple myeloma

Radiation therapy has no independent significance for this pathology, but it is used for bone lesions with large foci of bone tissue destruction, severe pain, and solitary myeloma. The total radiation dose is usually no more than 2500-4000 Gy.

Treatment and prevention of complications include:

1. Antibiotic therapy with broad-spectrum drugs for infectious complications;
2. Correction of kidney function in case of kidney failure (diet, diuretics, plasmapheresis and hemosorption, in severe cases - hemodialysis using an artificial kidney machine);
3. Normalization of calcium levels (forcing diuresis with diuretics, glucocorticoids, calcitrin);
4. The use of erythropoietin, transfusion of blood components for severe anemia and hemorrhagic syndrome;
5. Detoxification therapy with intravenous administration of medicinal solutions and adequate pain relief;
6. For bone pathologies, caltrin, anabolic steroids, and drugs from the group of biophosphonates (clodronate, zometa) are used, which reduce destructive processes in the bones and prevent their fractures. When fractures occur, osteosynthesis, traction, and possibly surgical treatment are indicated, exercise therapy is required, and local irradiation to the intended fracture site can serve as a preventive measure;
7. In cases of severe hyperviscose syndrome and kidney pathology caused by the circulation of a significant amount of tumor paraprotein, patients undergo hemosorption and plasmapheresis, which help remove large protein molecules from the bloodstream.

Bone marrow transplantation has not yet found widespread use for myeloma, since the risk of complications is still high, especially in patients over 40-50 years of age. Most often, transplantation of stem cells taken from the patient or donor is performed. The introduction of donor stem cells can even lead to a complete cure for myeloma, but this phenomenon is rare due to the high toxicity of chemotherapy, which is prescribed in the highest possible doses.

Surgical treatment of myeloma is rarely used, mainly in localized forms of the disease, when the tumor mass compresses vital organs, nerve roots, and blood vessels. Surgical treatment is possible in case of damage to the spine, aimed at eliminating compression of the spinal cord due to compression fractures of the vertebrae.

Life expectancy during chemotherapy in patients sensitive to it is up to 4 years, but resistant forms of the tumor reduce it to a year or less. The longest life expectancy is observed at stage IA - 61 months, and at stage IIIB it is no more than 15 months. With long-term chemotherapy, not only complications associated with the toxic effects of drugs are possible, but also the development of secondary tumor resistance to treatment and its transformation into acute leukemia.

In general, the prognosis is determined by the form of myeloma, its response to treatment, as well as the age of the patient and the presence of concomitant pathologies, but it is always serious and remains unsatisfactory in most cases. Cure is rare, and severe complications such as sepsis, bleeding, renal failure, amyloidosis and toxic damage to internal organs due to the use of cytostatics in most cases lead to a fatal outcome.

Prognosis for multiple myeloma

In addition to the patient’s age and physical condition, the prognosis of myeloma and life expectancy is reflected in the sensitivity of the tumor to drug treatment and the biological characteristics of plasma cells, in particular genetic abnormalities with deletion of chromosomal sections and amplification - gene duplication.

The concentration of paraproteins and their fractions, the volume of the lesion at the time of detection of the disease and the degree of involvement of other organs in the pathological process play a role, so that already developed renal failure will “outweigh” all other favorable signs of the disease.

It is very important for the patient’s life to choose the right doctor and clinic, where they can conduct an accurate examination and the patient is treated by a whole team of doctors of different specialties who know the clinical problems of an elderly myeloma patient and know how to solve them.

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Bibliography:

1. Davydov M.I., Aksel E.M./ Statistics of malignant neoplasms in Russia and the CIS countries 2007 // Bulletin of the Russian Cancer Research Center named after. N.N. Blokhina RAMS, 2009; 20 (3)
2. Kyle RA, Rajkumar SV./ Criteria for diagnosis, staging, risk stratification and response assessment of multiple myeloma// Leukemia. 2009; 23(1)
3. Durie BGM, Salmon SE. / A clinical staging system for multiple myeloma: Correlation of measure Myeloma cell mass with presenting clinical features, response to treatment, and survival// Cancer, 1975;36.
4. Facon T, Mary JY, Hulin C et al./ Melphalan and prednisone plus thalidomide versus melphalan and prednisone or reduced intensity autologous stem cell transplantation in elderly patients with multiple myeloma (IFM 99-06): a randomized trial// Lancet 2007; 370
5. Weber DM, Chen C, Nievisky R et al./ Lenalidomide plus dexamethasone for relapsed multiple myeloma in North America.// N Engl J Med 2007; 357.

General principles of therapy

Treatment of myeloma does not involve the use of radical methods, since the main goal of the course of therapy is to prolong and improve the quality of life. It is impossible to completely cure myeloma. However, in the fight against tumor damage, it is possible to slow down its development and induce remission.

After an accurate diagnosis of multiple myeloma, treatment is carried out using palliative methods to slow down the growth of the tumor and weaken the symptoms. Palliative treatments for myeloma include chemotherapy, radiation, and proper nutrition. Treatment with folk remedies at home is not recommended.

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Chemotherapy

The use of chemotherapy is the most effective method of combating myeloma. During the course of treatment, either one drug (monochemotherapy) or several medications (polychemotherapy) can be used.

When prescribing polychemotherapy, the following drugs can be used:

• Cyclophaosfamide;
• Melfan;
• Lenalidomide;
• Dexamethasone.

The drugs are taken orally or intravenously using intramuscular injections. When a course of chemotherapy is prescribed, treatment can be carried out according to one of several regimens:

• MP regimen - taking the drugs melphalan and prednisolone in tablet form.
• Regimen M2 - administration of intravenous injections of vincristine, cyclophosphamide and BCNU. At the same time, you need to take prednisolone and melphalan tablets for two weeks.
• VAD scheme - therapy is carried out in 3 sessions. During the first session, treatment is carried out with the drugs doxirubicin and vincristine. During subsequent sessions, you must take dexamethasone tablets.
• The VBMCP regimen is prescribed to patients under 50 years of age. On the first day of therapy, patients are given intravenous vincristine, cyclophosphamide and carmustine. Then you need to take melphalan and prednisolone for a week. After a month and a half, they are again given an injection of carmustine.

With any treatment regimen, medications are taken only under the strict supervision of specialists.

After treatment with chemotherapy, stable remission is observed in 40% of patients.

Radiation therapy

The use of radiation therapy is usually prescribed for solitary and large-focal tumors, when treatment with chemotherapy is powerless. In this case, it is possible to slow down the development of malignancy and weaken the clinical manifestations of the disease.

If radiation and chemical treatments are unsuccessful, patients undergo a bone marrow transplant. In approximately 40% of patients, stem cell transplantation helps achieve stable remission of the disease.

Symptomatic treatment

This treatment for multiple myeloma involves taking prescribed medications. Their action is aimed at relieving pain and adjusting the concentration of calcium in the blood. The drugs normalize blood clotting and stabilize kidney function.

Sometimes it is still possible to perform an operation to remove a single focus of myeloma, which is then subjected to cytological examination. If the disease is severe, patients may be prescribed morphine, buprenorphine and other narcotic drugs.

Nutrition

During treatment of the disease, it is imperative to adhere to proper nutrition. The diet for multiple myeloma is prescribed by the treating specialist. The diet should limit the consumption of foods high in protein. The patient needs to eat less meat, eggs, legumes and nuts.

Kidney Care Eating-Friendly Diet Tips

Multiple myeloma also causes kidney disease in some people. As cancer crowds out healthy blood cells, it can lead to bone destruction. This is important because your bones release calcium into your blood. Plasma cancer cells can also make a protein that ends up in your bloodstream.

Your kidneys have to work harder than usual to process the extra protein and extra calcium in your body. All this extra work can cause kidney damage.

Depending on how well your kidneys are functioning, you may need to adjust your diet to protect your kidneys. You may need to reduce the amount of salt, alcohol, protein and potassium you eat.

The amount of water and other liquids you drink may need to be limited if your kidneys are severely damaged. You may need to eat less calcium if your blood calcium levels are high because parts of your bone are being destroyed by cancer. Ask your doctor before making any dietary changes due to kidney disease.

What factors determine life expectancy with myeloma?

The main criteria on which life expectancy depends on this disease are: the activity of the tumor process and the stage of its development.

If the tumor is progressive, then the patient requires immediate treatment, which should be aimed at stopping the proliferation of malignant cells. If no measures are taken, the disease quickly moves into the next stage of development and the chances of remission and successful treatment are significantly reduced.

Also, the following factors play an important role:

Patient's health:

In order for the treatment to be successfully tolerated by the patient, stable functioning of the internal organs without any serious deviations is necessary. Because Traditional treatment for myeloma acts not only on malignant cells, but also on healthy cells, the patient will need maximum support for his body’s defenses.

Response to therapy:

The tumor may develop resistance (sometimes initial or acquired) to cytostatic treatment, so antitumor therapy sometimes does not bring results. The doctor must take into account the factor of resistance of malignant cells to the drug when prescribing treatment.

Quality of treatment:

The patient will prolong his life if he adheres to competent therapy prescribed by the attending physician.

Age:

The younger the patient, the higher the likelihood that the body will successfully cope with aggressive treatment without serious negative consequences.

Principles of nutrition

In case of myeloma, the diet must supply the body with a sufficient amount of complete protein. Per kilogram of human weight, two grams of protein per day are calculated. The daily diet should consist of foods containing calcium and vitamins C and B.

If a person is undergoing chemotherapy, then he is recommended to drink up to three liters of fluid per day. But only if the kidneys are functioning normally. As a liquid, you can drink tea, rosehip decoction, dried fruit compote, jelly, currant and blueberry decoction, boiled water.

Meals during the day should be fractional. Portions should be made small so as not to overload digestion.

It is recommended to cook food one time at a time. All semi-finished products and products that are stored for a long time should be excluded from consumption.

Nutrition depending on the concomitant condition

With a normal level of leukocytes, nutrition becomes expanded. Among protein products, preference should be given to beef and poultry, rabbit, liver and fish. It is better to get calcium from kefir, cottage cheese, and yogurt.

Simple carbohydrates are excluded from the menu. Otherwise, against the background of such products and taking glucocorticosteroids, blood sugar may increase.

If a person additionally suffers from an intestinal disorder, then the basis of the diet is decoctions, soups and liquid porridges made from rice cereals.

When there is a decrease in neutrophil levels, then nutrition becomes more limited. Only pasteurized dairy products are allowed to be included in the daily menu.

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Meat products must undergo thorough heat treatment. Eating undercooked meat, fish or poultry is prohibited. It is best to prepare steamed cutlets, meatballs and meatballs from meat products.

During the period of remission, nutrition becomes varied. The diet must contain a sufficient amount of useful microelements. There should be no strict restrictions during this period.

Perspective

Multiple myeloma is a relatively rare cancer, affecting about 1 in 143 people, according to the American Cancer Society. The average survival rate for stage I multiple myeloma is 62 months, which means that at 62 months, half of the people in this group were still alive.

However, treatments are constantly evolving, and many people with multiple myeloma may take part in clinical trials that test new drugs and treatments.

A healthy diet that reduces the symptoms of multiple myeloma and the side effects of chemotherapy can help improve a person's quality of life and keep them strong and comfortable during treatment.

Diet goals

Nutrition for multiple myeloma should help stimulate metabolism. A special diet also activates the properties of the immune system. All this helps fight tumors.

Properly selected nutrition for multiple myeloma will help cleanse the body. It will become easier for the internal system to tolerate potent medications.

It is important that the selected diet supplies the weakened body with the necessary energy. In this case, the composition of the blood must be taken into account.

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Nutrition should not negatively affect the level of important indicators, especially hemoglobin. It should be gentle, but complete.

The purpose of a therapeutic diet is to increase the body's resistance to malignancy. Properly selected products will be able to fight radionuclides and will help cleanse the body.

Dietary nutrition on time reduces the load on the liver and other organs, which are already significantly affected by chemotherapy sessions.

Diagnostics

The main method for diagnosing multiple myeloma is sternal puncture. The diagnosis is confirmed if more than 10% of tumor plasma cells are detected in the bone marrow punctate.

Serum protein electrophoresis can detect M-protein (monoclonal protein).

The third diagnostic criterion is dysfunction of organs and tissues. For ease of remembering, the abbreviation CRAB is used:

C – Calcium – hypercalcemia >2.75 mmol/l;

R – Renal – kidney damage, which is manifested by a creatinine level >173 µmol/l;

A – Anaemia – hemoglobin < 100 g/l;

B – Bone – radiological signs of bone damage.

Foods you can avoid

There are some foods that people with multiple myeloma may want to avoid to reduce their symptoms.

Foods to Avoid Kidney Damage

People with multiple myeloma may develop kidney damage. The breakdown of bone releases large amounts of calcium and protein into the bloodstream, which the kidneys diligently filter out.

If kidney function declines, people with multiple myeloma may need to limit their potassium, phosphorus, and fluid intake.

Foods high in potassium include:

• avocado
• bananas
• spinach and other leafy greens
• citrus
• tomatoes

Foods high in phosphorus include:

• whole wheat bread
• bran cereal
• oats
• nuts and sunflower seeds

For people who do not have multiple myeloma, foods high in potassium and phosphorus are not harmful. However, for those whose kidneys cannot filter out these minerals, the buildup of potassium and phosphorus can be dangerous.

The doctor closely monitors the kidney function of a person with multiple myeloma to determine whether potassium or phosphorus levels need monitoring.

Foods to Avoid During Chemotherapy

Although cancer itself can damage a person's immune system, cancer treatments, such as chemotherapy, can also damage a person's immune system. Damage to a person's immune system can put them at increased risk of infection.

Washing your hands and staying away from people who are sick is extremely important for people with weakened immune systems.

Certain foods may also cause further illness and infection in people undergoing chemotherapy. While a person with a healthy immune system can fight pathogens in food, a person with a weakened immune system would benefit from avoiding foods that may contain food-borne illnesses or bacteria.

• raw or undercooked meat, seafood and poultry
• deli meats that have not been heated to a safe internal temperature
• unpasteurized dairy products
• raw cabbage
• unboiled egg or foods containing it, such as cookies.

To safely cook and prepare food for a weakened immune system, a person should:

• Avoid bruises and damage to fruits and vegetables.
• wash all products thoroughly
• Do not consume food after the “use by” date or expiration date.
• Do not leave perishable foods outside at room temperature.
• Store raw meat and poultry in separate bags at the grocery store and keep them separate from each other in the refrigerator.

Disease prognosis

Myeloma is a serious and dangerous disease. Its prognosis is determined by laboratory parameters, the patient’s age, the stage of the disease, the degree of renal failure, the timing of the start of treatment, and the depth of bone lesions.

Solitary plasmacytoma often quickly develops into multiple myeloma. At stage 3B of the disease, the most unfavorable prognosis is observed. The average life expectancy is 15 months. At stage 3A - 30 months.

The average life expectancy for stages 2 and 1 A, B is from 4 to 5 years. If initial chemotherapy does not help, survival is less than a year.

Lifespan

A person diagnosed with multiple myeloma can live quite a long time; in clinical practice, there are cases when a cancer patient lived for 10-20 years after the disease was diagnosed. This is possible only if the disease does not have an aggressive course and is not accompanied by complications, and there are no errors in the prescribed therapeutic course.

But in almost half of the cases, the prognosis for this disease is unfavorable due to the impossibility of its early detection. The lack of proper treatment quickly causes an increase in the aggression of mutated cells, which transfers the disease to the incurable stage and leaves a person with only 1-2 years of life. a rare patient in this case can live 5 years.

What can you eat

The list of permitted products for multiple myeloma will depend on certain factors. If the blood test shows that the white blood cells are normal, then the following products are allowed:

• eggs and chicken;
• fish;
• liver;
• rabbit and beef;
• lean pork;
• cereals in the form of porridges;
• dried bread;
• fermented milk products;
• vegetable and fruit fruits;
• olive oil;
• flaxseed oil and fish oil.

Among cereals, preference should be given to rice, rolled oats, buckwheat, and millet. You can include pasta in your food. Porridge should be cooked in water or milk.

Vegetable fruits are best consumed boiled and stewed. These can be zucchini, potatoes, cabbage, carrots and beets, bell peppers. Fruits you should eat are pears and apples, bananas, oranges and tangerines.

The most useful products

If you have multiple myeloma, you need to include foods containing calcium in your diet. These are sesame and sunflower seeds, chickpeas and almonds, walnuts and hazelnuts. Dried fruits include figs and dried apricots.

If the disease occurs along with anemia, then the emphasis should be on foods such as shrimp and oysters. A sufficient amount of iron is contained in dried porcini mushrooms, spinach and legumes, cauliflower, apricots, raspberries and blueberries.

It is imperative to include foods that have antitumor effects in your daily diet. Sprouted grains can cope with intoxication of the body. Soy will help remove radionuclides. But it should be no more than 30 g per day.

Classification

Blood myeloma occurs with different symptoms, which depends not only on the stage, but also on the type of cancer process. The table presents the most diagnosed types of myeloma:

Classification	Kinds
According to the pathology	Plasmacytoma isolated or extramedullary
	Monoclonal gammopathy of unknown origin
	Lymphoplasmacytic or non-Hodgkin's lymphoma
	Multiple myeloma
According to the nature of the spread of pathological cells	Diffuse
	Diffuse nodular
	Multinodular
By cell composition	Plasmacytic
	Plasmablastic
	Polymorphic cell
	Small cell