Myeloma: symptoms and treatment

Myeloma disease

Myeloma (Rustitsky-Kahler's disease, plasmacytoma, multiple myeloma) is a disease from a group of chronic myeloblastic leukemias with lesions lymphoplasmocytic hematopoietic series, leading to the accumulation of abnormal similar immunoglobulins in the blood, the violation of humoral immunity and destruction bone tissue. Myeloma is characterized by a low proliferative potential of tumor cells that affect mainly bone marrow and bones, less often - lymph nodes and lymphoid tissue of the intestine, spleen, kidneys and other bodies.

Myeloma disease accounts for up to 10% of cases of hemoblastosis. The incidence of myeloma is an average of 2-4 cases per 100 thousand.

population and increases with age. Patients, as a rule, are more than 40 years old, children - in very rare cases.

Myeloma disease is more susceptible to representatives of the Negroid race and the male face.

Classification of myeloma

According to the type and prevalence of the tumor infiltrate, the local nodal form (solitary plasmacytoma) and the generalized (multiple myeloma) are isolated.

Plasmocytoma often has bone, more rarely - extra-extramedular (extra-medullary) localization.

Bone plasmacytoma is manifested by a single focus of osteolysis without plasma cell infiltration of the bone marrow; soft tissue - tumor lesion of lymphoid tissue.

It is subdivided into a multiple-knotty, diffusively-knotty and diffuse forms.

Taking into account the characteristics of myeloma cells, the plasma-cytoplasmic, plasmablastic, and low-differentiated (polymorphic-cellular and small-cell) myeloma are isolated.

Myeloma cells over-secret immunoglobulins of one class, their light and heavy chains (paraproteins). In this regard, the immunochemical variants of myeloma are distinguished: G A M D E- myeloma, Bence-Jones myeloma, non-secretory myeloma.

Depending on the clinical and laboratory features, 3 stages of myeloma are defined: I - with a small tumor mass, II - with an average tumor mass, III - with a large tumor mass.

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The causes of myeloma are not clear. Quite often, heterogeneous chromosome aberrations are determined. There is a hereditary predisposition to the development of myeloma.

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The rise in morbidity is associated with the effect of radioactive irradiation, chemical and physical carcinogens.

Myeloma is often detected in people who have contact with oil products, as well as tanneries, carpenters, farmers.

In myeloma, plasmocytes of varying degrees of maturity are detected with features of atypism differing from normal by large size (0 0 μm), pale coloration, multinucleation (often 3-5 nuclei) and the presence of nucleols, uncontrolled division and long term life.

The proliferation of myeloma tissue in the bone marrow leads to the destruction of the hematopoietic tissue, the suppression of normal sprouts of lympho- and myelopoiesis. The blood reduces the number of red blood cells, white blood cells and platelets.

Myeloma cells are not able to fully perform the immune function due to a sharp decrease in the synthesis and rapid destruction of normal antibodies.

Tumor factors deactivate neutrophils, reduce the level of lysozyme, disrupt the function of complement.

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Local bone destruction is associated with replacement of normal bone tissue with proliferating myeloma cells and stimulation of osteoclasts by cytokines.

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Around the tumor foci of dissolution of bone tissue (osteolysis) without zones of osteogenesis are formed. Bones soften, become brittle, a significant amount of calcium goes into the blood.

Paraproteins, entering the bloodstream, are partially deposited in various organs (heart, lungs, digestive tract, dermis, around the joints) in the form of amyloid.

Symptoms of myeloma

Myeloma in the preclinical period proceeds without complaints of poor health and can be detected only in the laboratory examination of blood.

Symptoms of myeloma are caused by plasmocytosis of bones, osteoporosis and osteolysis, immunopathy, impaired renal function, changes in the qualitative and rheological characteristics of the blood.

Usually, multiple myeloma begins to manifest itself in the ribs, sternum, spine, collarbones, humerus, pelvic and femur, arising spontaneously during movements and palpation.

Myeloma amyloidosis is manifested by the defeat of various organs (heart, kidney, tongue, GI tract), cornea of ​​the eye, joints, dermis and is accompanied by tachycardia, cardiac and renal insufficiency, macroglossia, dyspepsia, corneal dystrophy, joint deformity, skin infiltrates, polyneuropathy. Hypercalcemia develops during severe or terminal stages of myeloma and is accompanied by polyuria, nausea and vomiting, dehydration, muscle weakness, lethargy, drowsiness, psychotic disorders, sometimes - coma.

A common manifestation of the disease is myeloma nephropathy with persistent proteinuria, cylindruria.

Renal failure may be associated with the development of nephrocalcinosis, as well as with AL-amyloidosis, hyperuricemia, frequent urinary tract infections, hyperproduction of Bence-Jones protein, leading to damage renal tubules.

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With myeloma, Fanconi syndrome - renal acidosis with violation of urinary concentration and acidification, loss of glucose and amino acids, can develop.

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Myeloma is accompanied by anemia, a decrease in the production of erythropoietin. Due to pronounced paraproteinemia, there is a significant increase in ESR (up to 60-80 mm / h), an increase in the viscosity of the blood, a violation of microcirculation.

With myeloma, an immunodeficient condition develops, and susceptibility to bacterial infections increases. Already in the initial period, this leads to the development of pneumonia, pyelonephritis, having a severe course in 75% of cases.

Infectious complications are one of the leading direct causes of mortality in myeloma.

The syndrome of hypoculation in myeloma is characterized by hemorrhagic diathesis in the form of capillary hemorrhages (purpura) and bruises, bleeding from the mucous gums, nose, digestive tract and the uterus. A solitary plasmacytoma occurs at an earlier age, has a slow development, is rarely accompanied by damage to the bone marrow, skeleton, kidneys, paraproteinemia, anemia and hypercalcemia.

If there is a suspicion of myeloma, a thorough physical examination is performed, palpation of the painful areas of bones and soft tissues, chest and skeletal x-ray, laboratory tests, bone marrow aspiration biopsy with myelogram, trepanobiopsia. Additionally, blood levels of creatinine, electrolytes, C-reactive protein, b2-microglobulin, LDH, IL-6, and proliferation index of plasma cells are determined in the blood. Cytogenetic investigation of plasma cells, immunophenotyping of mononuclear blood cells is carried out.

With multiple myeloma, hypercalcemia, an increase in creatinine, a decrease in Hb

An important stage is the differentiation of myeloma with benign monoclonal gammapathy of undetermined genesis, macroglobulinemia Valdenstrom, chronic lymphocytic leukemia, non-Hodgkin's lymphoma, primary amyloidosis, bone metastasis of colon cancer, lung, osteodystrophy, etc.

Treatment and prognosis of myeloma

Treatment of myeloma begins immediately after verification of the diagnosis, which allows to prolong the patient's life and improve its quality.

With sluggish form, expectant tactics with a dynamic observation to the development of clinical manifestations are possible. Specific therapy of myeloma is carried out with the defeat of target organs (i.e. n.

CRAB - hypercalcemia, renal failure, anemia, bone destruction).

The main method of treating multiple myeloma is prolonged mono- or polychemotherapy with the appointment of alkylating drugs in combination with glucocorticoids. Polychemotherapy is more often indicated in stage II, III stages of the disease, stage I of Bens-Jones proteinemia, progression of clinical symptoms.

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After treatment of myeloma, relapses occur within a year, each subsequent remission is less attainable and shorter than the previous one. To prolong remission, supportive courses of a-interferon preparations are usually prescribed. Complete remission is achieved in no more than 10% of cases.

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In young patients in the first year of detection of myeloma after a course of high-dose chemotherapy autotransplantation of the bone marrow or blood stem cells is performed. With a solitary plasmacytome, radiation therapy is used that provides long-term remission, with ineffectiveness appointed chemotherapy, surgical removal of the tumor.

Symptomatic treatment of myeloma is reduced to correction of electrolyte disorders, qualitative and rheological parameters of blood, conduction of haemostatic and orthopedic treatment. Palliative treatment can include painkillers, pulse-therapy with glucocorticoids, radiation therapy, prevention of infectious complications.

The prognosis of myeloma is determined by the stage of the disease, the age of the patient, laboratory indicators, the degree of renal failure and bone lesions, the timing of the initiation of treatment. The solitary plasmacytoma often recurs with transformation into a multiple myeloma.

The most unfavorable prognosis for III B of myeloma is with an average life span of 15 months. At stage III A, it is 30 months, with II and I A, B stages -5 years. With primary resistance to chemotherapy, survival is less than 1 year.

A source: http://www.krasotaimedicina.ru/diseases/hematologic/multiple-myeloma

Myeloma - causes, symptoms, diagnosis, treatment and prognosis of the disease

If myeloma blood disease progresses, the destruction of plasma cells in the bone marrow, which mutate and acquire a malignant nature.

The disease refers to paraproteinemic leukemia, has the second name "Blood cancer".By nature it is characterized by a tumor neoplasm, the sizes of which grow at each stage of the disease.

The diagnosis is difficult to treat, it can result in an unexpected fatal outcome.

What is myeloma?

itan abnormal condition called "Rustitzky-Kahler's disease" shortens life expectancy.In a pathological process, cancer cells enter the systemic circulation, promote intensive production of pathological immunoglobulin - paraproteins.

These specific proteins, being transformed into amyloids, are deposited in tissues and disrupt the work of such important organs and structures as the kidneys, joints, heart. The general condition of the patient depends on the degree of the ailment, the number of malignant cells.

For the diagnosis is required differential diagnosis.

Plasma cell carcinoma of this variety is distinguished by a single focus of pathology, which is localized in the bone marrow and lymph node.

To establish the correct diagnosis of myeloma, it is required to conduct a number of laboratory studies, exclude the spread of multiple foci.

With myeloma bony lesions, the symptoms are similar, treatment depends on the stage of the pathological process.

Multiple myeloma

With this pathology, several bone marrow structures immediately become foci of pathology, which are rapidly progressing.

Symptoms of multiple myeloma depend on the stage of the lesion, and for clarity the thematic photos you can see below.

Myeloma of the blood affects the tissues of the vertebrae, scapula, ribs, iliac wings, skull bones related to the bone marrow.With such malignant tumors, the clinical outcome for the patient is not optimistic.

The progressing Bence-Jones myeloma at all stages of the disease is a significant threat to the life of the patient, so timely diagnosis is 50% successful treatment.Doctors distinguish 3 stages of myeloma pathology, in which the pronounced symptoms of the disease only increase and intensify:

1. The first stage. In the blood excess calcium, an insignificant concentration of paraproteins and protein in the urine, a hemoglobin index reaches 100 g / l, there are signs of osteoporosis. The focus of pathology is one, but it is progressing.
2. The second stage. The lesions become multiple, the concentration of paraproteins and hemoglobin decreases, the mass of cancer tissues reaches 800 g. Single metastases predominate.
3. The third stage. Progression of osteoporosis in the bones, there are 3 or more foci in the bone structures, the concentration of protein in the urine and calcium of the blood is maximized. Hemoglobin decreases pathologically to 85 g / l.

Causes

Myeloma of the bones progresses spontaneously, and the doctors could not determine the etiology of the pathological process until the end.One thing is known: people are at risk of exposure to radiation.

Statistics say that the number of patients after exposure to such a pathogenic factor has increased at times. Based on the results of long-term therapy, it is not always possible to stabilize the general condition of a clinical patient.

Symptoms of myeloma

With lesions of bone tissue in the patient, the first thing is the anemia of the unexplained ethology, which is not subject to correction even after a curative diet.

Characteristic symptoms are pronounced pain in the bones, the occurrence of a pathological fracture is not excluded.

Other changes in overall health in the progression of myeloma are presented below:

• frequent bleeding;
• impaired blood clotting, thrombosis;
• decreased immunity;
• soreness of the myocardium;
• increased protein in the urine;
• instability of the temperature regime;
• syndrome of kidney failure;
• increased fatigue;
• severe symptoms of osteoporosis;
• fractures of the spine in complicated clinical pictures.

Diagnostics

Because theThe first time the disease is asymptomatic and is not diagnosed in a timely manner, doctors reveal already complications of myeloma, suspicion of kidney failure. Diagnostics includes not only visual examination of the patient and palpation of soft, bone structures, in addition, it is required to undergo clinical examinations. It:

• chest and skeletal x-ray to determine the number of tumors in the bone;
• aspiration bone marrow biopsy for checking the presence of cancer cells in myeloma pathology;
• trepanobiopsy - a study of a compact and spongy substance taken from the bone marrow;
• Myelogram is necessary for differential diagnosis, as an informative invasive method;
• cytogenetic study of plasma cells.

Treatment of myeloma

In uncomplicated clinical pictures from surgical methods are used: transplantation of donor or own stem cells, highly dosed chemotherapy with the use of cytostatics, radiation therapy.

Hemosorption and plasmaphoresis are appropriate for hypervisual syndrome, extensive renal damage, renal insufficiency.

Medication therapy lasting several months with myeloma pathology includes:

• anesthetics for the elimination of pain in the bones;
• antibiotics of the penicillin series with recurrent infectious processes inside and intravenously;
• hemostatics for the control of intensive haemorrhage: Vikasol, Etamsilat;
• cytostatics for the reduction of tumor masses: Melphalan, Cyclophosphamide, Chlorbutin;
• glucocorticoids in combination with abundant drink to reduce the concentration of calcium in the blood: Alkeran, Prednisolone, Dexamethasone.
• immunostimulants with interferon content, if the disease was accompanied by a decrease in immunity.

If, with the growth of a malignant tumor, there is an increased pressure on neighboring organs with their subsequent dysfunction, doctors decide to urgently remove such pathogenic neoplasm. The clinical outcome and potential complications after the operation can be the most unpredictable.

Nutrition for myeloma

To reduce the recurrence of the disease, treatment should be timely, with the diet included in the complex scheme.

Adhere to this nutrition is required throughout life, especially with the next exacerbation.

Here are valuablerecommendations of dietary experts for plasmacytosis:

• reduce to a minimum the consumption of protein foods - no more than 60 g of protein per day is allowed;
• to exclude from the daily ration such food products as beans, lentils, peas, meat, fish, nuts, eggs;
• Do not eat foods on which the patient may develop acute allergic reactions;
• regularly take natural vitamins, adhere to intensive vitamin therapy.

Forecast

If the patient is not treated, then he may die from myeloma in the next 2 years, while the daily quality of life is regularly reduced.

If you systematically undergo chemotherapy with the participation of cytostatics, the life expectancy of a clinical patient increases to 5 years, in rare cases - up to 10 years.

Representatives of this pharmacological group in 5% of clinical pictures provoke acute leukemia in the patient.Doctors do not exclude a sudden death if it progresses:

• stroke or myocardial infarction;
• malignant tumor;
• blood poisoning;
• renal insufficiency.

A source: http://vrachmedik.ru/586-mielomnaya-bolezn.html

Myeloma: symptoms and treatment

Category: Heart, blood vessels, blood 104461

Myeloma (multiple myeloma) is a disease that occurs in the blood system and belongs to the paraproteinemic leukemia group.

Myeloma, the symptoms of which are manifested by the appearance of a tumor in B-lymphocytes, in the most frequent cases are noted among the elderly, and only in rare cases is it possible to appear before the age of forty years.

general description

Causes that contribute to the development of myeloma, to this day and remain unknown.

Among the potential risks contributing to its occurrence, contact with pesticides and radioactive substances, with benzene, as well as with certain types of organic solutions, is distinguished.

In general, the manifestations of myeloma are characterized by the multiplicity of the appearance of its inherent tumor lytic formations focused in the bones, osteoporosis, as well as diffuse plasmacytosis, localized in the bone brain. Circulation of myeloma proteins produced by plasmatic cells in a significant amount occurs in plasma, due to which it becomes possible to increase its volume, as well as the general viscosity inherent in later blood. There is an interaction of myeloma proteins and factors contributing to blood clotting, due to which they enclose platelets. This has a corresponding effect on the function of the latter, thereby increasing their bleeding.

Plasmotic cells, in addition to myeloma proteins, also have the ability to produce various type of cytotoxic factors, for example, those factors that can activate the function osteoclasts. Already at the expense of osteoclasts, resorption of bone tissue is caused, which is manifested for the patient in pain in bones and pathological fractures. In addition, hypercalcemia is also formed.

As a result of the infiltration in the bone marrow, anemia occurs, and it can manifest itself in a variety of degrees of severity.

Also the consequence of infiltration is leukopenia or / thrombocytopenia.

As a result of a decrease in the total number of leukocytes, as well as violations in the synthesis of immunoglobulins possible becomes manifestation in the form of depression of humoral immunity, as well as immunity of cellular (less degree). This circumstance determines the increased sensitivity of patients in relation to a number of infections (mainly bacterial).

Classification of myeloma

Myeloma disease can occur in several variants of the development of the process, which are determined in part by the nature of the spread, characteristic of myeloma infiltrates in the bone marrow, as well as the nature of the directly myeloma cells and the type of synthesized paraprotein.

• Depending on the nature of the prevalence of the tumor in the bone marrow, the following forms of myeloma are determined:
• diffuse myeloma;
• myeloma diffuse-focal;
• focal myeloma.
• Depending on the characteristics of the cellular composition, the myeloma is determined:
• Plasmoblast;
• Plasmocyte;
• small-celled;
• polymorphic-cellular.
• Depending on the inherent secretion of certain types of paraproteins, the following types of disease are determined:
• nonsecretory myeloma;
• myocloma dyclone;
• myeloma of Bence-Jones;
• M A G-myeloma.

The most common variants are Bence-Jones myeloma (15% of the total number of observations), and A- (20%) and G-myeloma (70%).

Symptoms of myeloma

For a long time myeloma can be characterized by its own asymptomatic course, manifesting itself only in an increase in the indicator in the analysis of the blood of the ESR.

Subsequently, her development develops a frequent state of weakness, the patient is losing weight, in addition, he also has pain in the bones.

Manifestations of external character often arise due to damage to bones, as well as immunity, anemia, increased blood viscosity, changes in kidney function.

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It is noteworthy that pain in the bones is the most common sign, indicating the presence of myeloma.

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The localization of pains mainly focuses on the area of ​​the ribs and spine, and they are felt mainly during the movement.

Localized in certain areas of pain of an uninterrupted type, usually indicate the presence of fractures.

In myeloma, bone destruction is caused by the actual process of growth that occurs in the tumor clone.

Due to the destruction of bones, mobilization of calcium bones occurs, which, in turn, leads to the appearance of characteristic complications in the form of nausea and vomiting, and also to drowsiness and, in some cases, to coma.

As a result of subsidence of the vertebrae, signs appear that indicate the compression of the spinal cord. Due to this, carrying out the roentgenogram makes it possible to determine whether the presence of foci of destruction in the bone tissue, or the general form of osteoporosis.

Due to the increased viscosity of the blood in patients with myeloma, a neurological symptomatology, which manifests itself in the form of headaches, visual disturbances, fatigue, defeat of the eye retina. Some patients face the appearance of "goose bumps" in the feet and hands, as well as their tingling and numbness.

For the initial stage of the disease, the absence of any changes in blood can be inherent.

Meanwhile, about 70% of patients experience the development of increasing anemia, which occurs under the influence of the process replacement of bone marrow tumor cells, as well as oppression of the hematopoietic function by actual tumor factors.

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In some cases, anemia acts as the initial and, at the same time, the main manifestation of the disease under consideration.

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As we have already noted, there may be an increase in ESR, which is in itself a classic manifestation of myeloma. In some cases, the ESR is about 90mm / h.

Varying is observed in the number of leukocytes, as well as in the leukocyte formula.

An expanded picture of myeloma determines the possibility of reducing the level of indicators of the total number of leukocytes, in addition, in many cases, myeloma cells are detected.

Diagnosis of myeloma

The cytological picture, typical for bone marrow punctate, has about 10% of myeloma cells, which differ significantly diversity in structural features, as well as atypical cells of the plasmoblast type, which are also very specific for the considered diseases

Classical components in the symptomatology of myeloma are represented in the form of plasmacytosis of the bone brain (more than 10%), urinary or serum M-component, as well as in the form of osteolytic lesions. The reliability of the diagnosis is determined on the basis of the presence of the first two components.

An additional role in the diagnosis is played by changes in the bones, determined by the X-ray method. An exception may be extramedullary myeloma, the process of which often occurs in combination with the involvement of lymphoid nasopharyngeal tissue, as well as paranasal sinuses.

Myeloma: treatment

Following the establishment of a diagnosis of myeloma, it is generally recommended that appropriate treatment be prescribed.

The tactic of waiting is justified solely with a slow-moving form of the disease, in which there is a lack of characteristic manifestations.

In this situation, patients are assigned a dynamic observation, treatment is prescribed for the progression of the disease.

The main criterion, indicating the need for a specific type of therapy for myeloma, is the presence of lesions in the target organs.

The main method of treatment is chemotherapy with the use of cytotoxic drugs.

In addition, the actual introduction of symptomatic treatment, focused on adequate correction of hypercalcemia.

It also uses analgesics, haemostatic and orthopedic therapy.

As a palliative treatment, radiotherapy is used, used for patients in a weakened state, and also in case of renal insufficiency and with tumor resistance in relation to the applied chemotherapy.

Often, radiation therapy is also applicable in the case of the formation of local bone lesions.

Myeloma: predictions

Due to the peculiarities of modern treatment, the life of patients with myeloma can be extended on average by 4 years.

The sensitivity to the treatment used with the use of cytostatic agents largely determines the duration of life, patients with a primary resistance in terms of their treatment, the average survival rate varies between up to a year.

Long-term treatment with the use of cytostatic agents leads to an increase in the occurrence of acute forms of leukemia (of the order of up to 5%), in rare cases, the development of acute leukemia is noted in patients without the use of this type treatment.

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The life expectancy is also determined by the stage during which the diagnosis was established.

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As the causes of death, the progression of myeloma, sepsis, renal failure is determined.

Some patients die due to stroke, myocardial infarction, and a number of other causes.

In the case of the appearance of a characteristic myeloma symptomatology, it is necessary to consult such specialists as a hematologist and an oncologist.

Diseases with similar symptoms:

Encephalopathy of the brain (concurrent symptoms: 7 of 14)

Encephalopathy of the brain is a pathological condition in which the insufficiency of the supply of oxygen and blood to the brain tissue leads to the death of its nerve cells. As a result, there are regions of decay, blood stasis, small local areas of hemorrhage are formed, and edema of meninges is formed. Affects the disease mainly white and gray matter of the brain.

... Acute leukemia (concurrent symptoms: 7 of 14)

This disease is difficult to cure, often leads to death, salvage in many cases can only be a bone marrow transplant.

Fortunately, the disease is quite rare, no more than 35 cases of infection per 1 million of the population are registered each year. Who is more often faced with such an unpleasant diagnosis of children or adults?

... Hydrocephalus (coinciding symptoms: 6 of 14)

Hydrocephalus, which is also commonly accepted as a dropsy of the brain, is a disease, at which there is an increase in the volume of the ventricles in the brain, and often - to very impressive sizes.

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Hydrocephalus, the symptoms of which are manifested due to excessive production of cerebrospinal fluid (cerebrospinal fluid between the communicating ventricles of the brain) and its congestion in the region of the brain cavities, mainly occurs in newborns, but this disease and place in the incidence of other age categories.

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... Concussion of the brain (coinciding symptoms: 6 of 14)

Concussion is a pathological condition that occurs when a head trauma is obtained in a specific way.

Concussion, the symptoms of which are in no way associated with vascular pathologies, is accompanied by a sudden disruption of brain function.

What is noteworthy is that, when an injury is received, a concussion of the brain is diagnosed in about 80% of cases.

... Ischemic disease of the brain (coinciding symptoms: 6 of 14)

...

• In contact with

A source: http://SimptoMer.ru/bolezni/serdtse-i-sosudy/112-miyelomnaya-bolezn-simptomy

Myeloma: symptoms, treatment and prognosis, blood test, photo, laboratory diagnosis

Myeloma has many synonymous names. In speeches of specialists, it can be designated as generalized plasmacytoma, reticuloplasmocytosis, Rustitzky-Kahler's disease or myelomatosis. The most commonly used of these are the terms myeloma and myeloma.

As a form of hemoblastosis, myeloma is a malignant tumor characterized by the accelerated growth of plasmocytes - cells that produce paraprotein (a pathological protein).

The mutation that affects these cells leads to the fact that their number in the tissues of the bone marrow and in the blood is steadily growing. Accordingly, the amount of paraprotein synthesized by them grows.

The picture shows a bone marrow smear with multiple myeloma and without

The main criterion for malignancy of myeloma is the number of transformed plasmocytes many times higher than normal.

Unlike oncological diseases that have a clear localization (for example, tumors of the intestine or ovaries), myeloma characterized by the presence of cancer cells in several internal organs, as they can be carried along with the current blood.

• Myeloma develops when the processes of proper development and transformation of B-lymphocytes into cells of the immune system-plasmocytes-are disturbed. At the same time, the synthesis of immunoglobulins produced by them (antibodies that help to destroy pathogenic viruses and bacteria) is inevitably disrupted.
• Myeloma is a malignant tumor formed by constantly multiplying monoclonal plasmocytes, which not only do not perish but divide and synthesize the paraproteins uncontrollably. Penetrating (infiltrating) into tissues and internal organs, paraproteins interfere with their normal functioning.
• Myeloma develops mainly in mature (over forty years) and elderly patients. For young people, this disease is not typical. The older the patient, the higher his risk of developing myeloma, and it infects men more often than women.
• Myeloma growth is extremely slow. The moment of formation of the first plasmocytes in bone marrow tissues and the beginning of the formation of tumor foci can divide two or even three decades. But after the clinical manifestations of myeloma are known, it begins to progress dramatically. Already two years after that, the vast majority of patients die from numerous complications that developed in those organs and systems that were affected by paraproteins.

The basis for the classification of myeloma is the clinical and anatomical features of the presence of plasmocytes in the tissues of the bone marrow, as well as the specificity of their cellular composition. On how many organs or bones are affected by the tumor, the division of myelomas into solitary and multiple depends.

• Solitary myelomadiffer by the presence of only one tumor focus located either in the lymph node or in the bone that has bone marrow.
• Multiple myelomaalways hit a few bones containing the bone marrow. Myeloma often affects bone marrow tissue of vertebrae, scapula, wings of the ilium, ribs, and skull bones. Malignant tumors are often formed in the central part of the tubular bones of the upper and lower extremities. Equally vulnerable are the spleen and lymph nodes.

Depending on the location of the plasmocytes in the bone marrow of myeloma there are:

• diffuse foci;
• diffuse;
• multiple-focal.

Cellular composition of myeloma allows to divide them into:

• plasmacytic;
• plasmablastic;
• polymorphic cell;
• small-celled.

Causes

Like most cancer diseases, the true causes of myeloma are still not established. The nature and extent of the impact of pathogenic factors on the transformation of damaged cells has also been little studied.

Physicians suggest that the main causes of myeloma disease can be considered:

• Genetically determined predisposition.This ailment often affects very close relatives (they are often affected by identical twins). All attempts to identify oncogenes, provoking the development of the disease, have not yet been successful.
• Long-lasting action of chemical mutagens(as a result of inhalation of mercury vapors and domestic insecticides, asbestos and benzene-based substances).
• The impact of all types of ionizing radiation(protons and neutrons, ultraviolet, X-ray and gamma rays). Among the population of Japan, survived the tragedy of Hiroshima and Nagasaki, myeloma is extremely frequent.
• The presence of chronic inflammation, which requires a prolonged immune response from the patient's body.

Stages of

The extent of the lesion and the severity of the course allow us to distinguish three stages of myeloma.At the first stage, the tumor process fits into the following parameters:

• The blood contains a sufficient amount of calcium.
• The level of hemoglobin concentration exceeds 100 g / l.
• There are still a few paraproteins in the blood.
• The Bence-Jones protein in the urine is present in a very small concentration (no more than 4 g per day).
• The total mass of myeloma does not exceed 600 g per square meter.
• There are no signs of osteoporosis in the bones.
• Tumor focus is in only one bone.

The third stage of myeloma is characterized by the presence of the following parameters:

• hemoglobin in the blood is less than 85 g / l.
• calcium in 100 ml of blood exceeds 12 mg.
• Tumors have captured three bones (or more) at once.
• The content of paraproteins is very high in the blood.
• Very high (over 112 g per day) is the concentration of the Bence-Jones protein.
• The total mass of cancer tissues is more than, kg.
• The radiograph shows the presence of osteoporosis in the affected bones.

The second degree of myeloma, whose indices are higher than the first, but do not reach the third, the doctor establishes by the method of exclusion.

Disorders of organs and symptoms

Myeloma mainly affects the immune system, kidney and bone tissue.

Symptomatic is determined by the stage of the disease. At first it can be asymptomatic.

With an increase in the number of cancer cells, myeloma manifests itself as follows:

• Aching in the bones.Cancer cells lead to the formation of voids in bone tissues.
• Pain in the heart muscle, tendons and joints, due to the deposition of paraproteins in them.
• Pathological fractures of vertebrae, femurs and ribs.Because of the large number of voids, the bones become so fragile that they can not withstand even small loads.
• Decreased immunity. Affected by the disease, the bone marrow produces such a small amount of leukocytes that the patient's body is not able to protect itself from the effects of pathogenic microflora. As a result, the patient suffers from endless bacterial infections - otitis, bronchitis and angina.
• Hypercalcemia.The destruction of bone tissue leads to the ingress of calcium into the blood. In this case, the patient develops constipation, nausea, abdominal pain, weakness, emotional disorders and inhibition.
• Myeloma nephropathy- a violation of the proper functioning of the kidneys. Excess calcium causes the formation of stones in the renal ducts.
• Anemia.The damaged bone marrow produces less and less red blood cells. As a result, the amount of hemoglobin responsible for oxygen delivery to cells also decreases. Oxygen starvation of cells is manifested in severe weakness, decreased attention. At the slightest burden, the patient begins to suffer from palpitations, headaches and shortness of breath.
• In violation of blood coagulability.In some patients, the viscosity of the plasma increases, because of which spontaneously sticking red blood cells can form thrombi. Other patients, in whose blood the number of thrombocytes has sharply decreased, suffer from frequent nasal and gingival hemorrhages. When the capillaries are damaged, subcutaneous hemorrhage occurs in these patients, which are manifested in the formation of a large number of bruises and bruises.

Laboratory diagnostics

Diagnosis of myeloma begins with a preliminary medical examination. Collecting the anamnesis, the expert in detail asks the patient about existing complaints and features of the clinical picture, not forgetting to specify the time of their appearance.

After this, the obligatory palpation of the painful parts of the body follows with a series of clarifying questions about whether pain intensification occurs and if its return is present in other parts of the body.

Having collected the anamnesis and came to the conclusion about the possibility of myeloma, the specialist assigns to the patient a number of such diagnostic studies:

• Chest X-ray and skeleton.

The photo shows the X-ray of the arm bone showing myeloma

• Magnetic resonance and computed tomography (spiral).
• Aspiration of the bone marrow tissues necessary to create a myelogram.
• Laboratory analysis of urine (according to Zimnitsky and general). Analysis of Zimnitskiy allows one to trace the daily dynamics of protein loss in urine. The analysis of urine for bons-jons protein is performed in order to verify the correctness of the diagnosis, since the urine of a healthy person does not contain it.
• Bens-jons proteins can also be detected during the immunoelectrophoresis procedure.

Blood test

• To assess the general condition of the hematopoietic system, a general analysis of 1 ml of blood taken from the vein or from the finger is carried out.

  The presence of myeloma will be evidenced by: an increase in ESR, a significant decrease in the content hemoglobin, erythrocytes, reticulocytes, thrombocytes, leukocytes and neutrophils, but the level of monocytes will be elevated.

  The increase in the total amount of proteins is achieved due to the content of paraproteins.

• To assess the functioning of individual systems and organs, conduct a biochemical analysis of blood taken from the vein.

  The diagnosis of myeloma is confirmed by a complex of indicators in the blood, among them: an increased level of total protein, urea, creatinine, uric acid, calcium with a decrease in albumin content.

Methods of treatment

• The leading method of treatment of myeloma is chemotherapy, which is reduced to taking high doses of cytotoxic drugs.
• After effective chemotherapy, patients undergo transplantation of donor or own stem cells.
• When the effectiveness of chemotherapy is low, radiotherapy methods are used. The impact of radioactive rays does not heal the patient, but for a while it makes it possible to significantly alleviate his condition, in addition, increasing his life span.
• From excruciating pains in bones get rid by means of anaesthetising preparations.
• Infectious diseases are treated with high doses of antibiotics.
• Hemostatics (such as vicasol and etamzilate) will help cope with bleeding.
• From tumors squeezing internal organs, get rid of by surgical means.

Stem cell transplantation

If the chemotherapy is successful, the patient is transplanted with his own stem cells. For bone marrow sampling, perform a puncture.

Separating stem cells from it, they again plant them in the patient's body.

With this manipulation it is possible to achieve a stable remission, during which the patient feels healthy.

Dietary food

• The diet for myeloma should be low-protein. The daily amount of protein consumed should not exceed 60 g.
• In an extremely small amount, you should consume beans, lentils, peas, meat, fish, nuts, eggs.
• All other products well perceived by the patient can be safely included in the diet.

Modern methods of treatment can prolong the life of a patient suffering from myeloma, for almost five years (in very rare cases - up to ten).

In the absence of therapeutic assistance, he can live no more than two years.

The lifespan of patients depends solely on their susceptibility to the effects of cytotoxic drugs. If the cytostatics do not have any positive therapeutic effect on the patient (doctors call this primary resistance), he can live no more than a year.

If treatment with cytostatic drugs is carried out for a long time, the patient may develop acute leukemia (the frequency of such cases is up to 5%). The incidence of acute leukemia in patients who did not receive such treatment is extremely rare.

Another factor affecting the life expectancy of patients is the stage of diagnosing the disease.The causes of deaths can be:

• the progressing tumor itself (myeloma);
• infection of blood (sepsis);
• stroke;
• myocardial infarction;
• renal insufficiency.

About the symptoms of myelomatosis will tell this video:

A source: http://gidmed.com/onkologiya/lokalizatsiya-opuholej/krov-i-limfa/mielomnaya-bolezn.html