Multiple myeloma life expectancy

Multiple myeloma is a life threatening cancerous disease. Its prevalence is more in men than in women. It is likely to be attacked in 40’s. People who are occupied in petroleum, leather and agriculture are more likely to be affected by multiple myeloma. The treatment is initiated after going through the diagnostic process. Based on the nature and severity of the disease, various kinds of treatment methods are used. The purpose of the treatment is to contain the disease. The life expectancy of the patient will be increased by using various kinds of treatment techniques including radiation, chemotherapy and administration of drugs. A blood transfusion will be done to prevent further spread of infections.

Treatment objectives

The objective of the treatment is to prevent the spread of disease to other parts as well. If the activity of the disease can be localized, it is possible to make the most from the treatment. The treatment will be customized as per the requirements of the patient. No standard therapy is present for treating the patients who are suffering from multiple myeloma.

Before starting the treatment, a number of factors will be taken into consideration. The general state of health of the patient will be ascertained. The existing medical risks and probable future risks are taken into account before treating the patient. Pain management will also be done through experts. How the patient is responding to the initial treatment will decide the future course of action.

Multiple myeloma

Clinical trials

There were established therapies that can be used for treating the patients suffering with Multiple Myeloma. The therapies are documented in various scientific journals. In certain cases, clinical trials are carried out so that the new set of treatment procedures will be applied to the patient. This is done for eligible patients only. The disease will be classified and status will be reported. Based on the status, further treatment will be carried out.

Life expectancy

The life expectancy in patients suffering from multiple myeloma is dependent on the severity of the disease and the response to the treatment. There are a number of treatment alternatives which will be selected very carefully based on the health condition of the patient. The purpose of the treatment is to reduce the presence of plasma cell population.

In recent years, blood transfusion is giving great results and there is great improvement in the life expectancy. The treatment is ensured to achieve normal living conditions for patients as long as they survive and to increase the life expectancy through various treatment options. If there is an excess presence of calcium in the blood, it will lead to renal failure. Hence, calculated approach should be taken to tackle the disease.

The patient should cooperate to conduct various kinds of tests and to undergo new clinical trials based on their eligibility. The treatment will be offered in various levels. After going through the initial treatment options, it is required to go through the maintenance phase. The response rate in young patients is better than older patients.

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Multiple myeloma life expectancy can be increased

Multiple myeloma life expectancy is the first thing that will haunt your mind if you or your loved one is suffering from multiple myeloma. Multiple myeloma is cancer, if you put across in simple words. The word cancer creates a lot of mental stress as people believe that their life has come to an end. If your loved one is suffering from multiple myeloma then it is your responsibility to explain them about multiple myeloma life expectancy. This will make them aware about the time that they have in life and at the same time, they will also be aware of the responsibilities that they need to fulfil before they become bedridden.

What is the multiple myeloma life expectancy?

You can do some research on the internet or you can just meet up some doctor so that you can get an idea about the multiple myeloma life expectancy. Few of the facts about the multiple myeloma life expectancy are discussed below.

As per medical research, the multiple myeloma life expectancy would be around 3-5 years. If a patient is suffering from multiple myeloma then they will take a lot of precautions so that they can lead a normal life. If the patient is really working hard to stick to the regime that has been recommended by the medical professional then the life expectancy can be extended to 8 years. Only one third of multiple myeloma patients live for more than 5 years.

There are various medications which are introduced in the market and these medications promise that the multiple myeloma life expectancy can be increased to 16-20 years. The effect of this medicine is hardly known to any and hence, if you are planning to recommend the same to your family members or friends then you should do your part of research. Multiple myeloma life expectancy may seem to be a complicated thing to understand but the patient should be willing to go through all this pain rather than that of quitting.

Multiple myeloma life expectancy

How to increase the multiple myeloma life expectancy?

If your loved one is suffering from multiple myeloma then you should give them hope that the multiple myeloma life expectancy can be increased. Few of the ways by which the multiple myeloma life expectancy can be increased are as follows: -

  1. Multiple myeloma life expectancy is increased if you are active. You should undertake regular exercise as exercising allows your bones to be strong. The spread of multiple myeloma can be reduced to a great extent.
  2. If you are willing to increase multiple myeloma life expectancy then you should drink lots of fluids. If the intake of fluids is reduced then there are possibilities that the kidney may stop with the purification process and this is very risky.
  3. Multiple myeloma life expectancy can be increased only when you co-ordinate with your doctor. You should only eat the medicines that are recommended by the doctor rather than that of following an alternative regime.

Multiple myeloma life expectancy should be known to the multiple myeloma patient so that they can be mentally relaxed and this will reduce stress.

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Multiple myeloma case study

Multiple myeloma case study , Multiple myeloma (MM) is characterized by neoplastic proliferation of a
clone of plasma cells, which produces a protein in the majority of cases Monoclonal. This proliferation in bone marrow often invades bone adjacent, it produces destruction of the skeleton, and causes bone pain and fractures.

In addition, other important features are anemia, hypercalcemia, and failure Renal. The incidence is approximately 4 to 5 x 100,000, with higher incidence in the black population, and the average age at diagnosis is 65 years (only 3% of the) cases are under the age of 40). In recent years there is an increase in cases, the which seems to be related with the diagnosis more precocious.

OBJECTIVES

  • Confirm or make accurate diagnosis of this disease
  • Determine the extent (stage) in each patient.
  • Determine the extent (stage) in each patient.
  • Establish, in each case, the most appropriate therapeutic strategy that we achieve a prolonged survival.

DEVELOPMENT
The following steps are:

  • Diagnosis of certainty and histological classification by the Department of Pathologic Anatomy of our hospital.
  • Determination of the stadium.
  • Definition and application of therapeutic
  • Reassessment by completing the treatment and definition of the behavior
  • Regular evaluation

Clinical aspects

  • More than 70% of the cases presented bone pains, mostly located in the back and the chest. The pain is caused by the movements and usually does not arise at night while the patient sleeps. This It is a fact that may help in the differential diagnosis of metastasis bone.
  • The patient’s height can be reduced in several inches as consequence of vertebral crushing.
  • There may be symptoms related to the presence of anemia, infections, renal failure and hypercalcemia.
  • Pallor is the sign most frequent physical examination. They are rare the hepatomegaly and splenomegaly. Manifestations may occur hemorragiparas and may occasionally appear plasmacytomas extramedullary.

Paraclinical aspects

  • At most 70% of the cases a normocytic anemia occurs normochromic.
  • 98% of cases have a paraprotein serum or urinary tract at the time the diagnostic
  • Protein electrophoresis shows a peak monoclonal antibody in 80% of the patients, hypogammaglobulinemia in approximately 10% and is of normal appearance in the rest.
  • Serum immunoelectrophoresis evidence a paraprotein IgG in 53 %, IgA in 20%, light chains only in 17%, IgD in 2% and a gammopathy biclonal at 1%, and 7% has no serum paraprotein.
  • Urine studies demonstrate a paraprotein in 75% of the patients.
  • The study of light chains shows a 2:1 kappa/lambda ratio
  • In the medulograma and biopsy of bone marrow plasma cells can represent from 10% up to 100% of nucleated cells.
  • Radiological studies of the skeleton show lesions in more than 80% cases which may be characteristics injured OSTEOLYTIC in punch, osteoporosis and fractures. The bones most affected are the vertebrae, skull, rib cage, pelvis and proximal region of the femur and humerus.
  • Hypercalcemia and increased creatinine can be detected in 20% cases the diagnosis.

Diagnostic criteria

  • The minimum criteria for the diagnosis of MM are:
    ¾ More than 10% of plasma cells in the bone marrow. ¾ a paraprotein serum presence (generally greater than 3 g/dL) Presence of a urinary paraprotein ¾ ¾ Osteolytic lesions
    1 and at least one of the other three criteria required
  • These data are not related: metastatic carcinoma, conectivopatia, lymphomas or chronic infection.
  • Must be in the differential diagnosis of monoclonal gammopathy of Myeloma latent and unknown cause

Stadiums Classification of Durie and Salmon
Stadiums Classification of Durie and Salmon
Diagnosis studies

  • Interrogation
  • Physical exam
  • Imaging: ¾ x-ray bone survey (skull, spine, pelvis and areas of pain) ¾ Abdominal Ultrasound
  • Hematological studies ¾ blood count, erythrocyte sedimentation rate, medullogram, bone marrow biopsy, coagulation studies, platelet function.
  • Blood chemistry ¾ Glycemia, creatinine, urate, total protein, albumin, bilirubin, calcium, phosphorous, SGPT, SGOT, FAS, LDH, GGT, protein electrophoresis
  • Serological studies: VDRL, HIV, HBV, HCV, HTLV-I
  • Immunoelectrophoresis serum and light chains
  • Quantification of immunoglobulins
  • cyturia, proteinuria 24 hours
  • Other studies ¾ Coombs Test ¾ Blood ¾ C-reactive protein Β ¾ – 2 microglobulin

Treatment
At present therapeutic options for patients with symptomatic MM ranging from pulse dexamethasone with or without thalidomide, conventional chemotherapy and high-dose chemotherapy with hematopoietic cell transplantation (HCT).

The choice of treatment depends on the age, general condition of the patient and the patient’s opinion or preference. The 5 current therapeutic strategies in the MM are:

  • High doses of corticosteroids (dexamethasone or methylprednisolone)
  • Thalidomide (alone or combined with high-dose dexamethasone)
  • Conventional Chemotherapy: VAD, melphalan / prednisone, prednisone, cyclophosphamide, VMCP, MOAP.
  • TCH, autologous or allogeneic, of peripheral blood progenitor cells.
  • proteasome inhibitors (bortezomib)

Recommended

  • If the patient is under 60 years and the possibility of autologous hematopoietic progenitor cells from peripheral blood is recommended induction treatments containing no alkylating agents such as VAD.
  • If the patient is under 50 years Consideration should be given allogeneic transplantation and HLA study performed.
  • In patients older than 60 years and patients without criteria for autologous HCT, the scheme is recommended melfalan- prednisone. This is not strict and depends on the condition of the patient.
  • Patients with renal impairment should be treated with VAD, high-dose dexamethasone or dexamethasone-thalidomide.
  • Induction therapy will remain at least 6 months until obtain a therapeutic response classified as favorable.
  • It will study protein electrophoresis and blood chemistry during induction treatment every two months

High doses of corticosteroids

  • Dexamethasone at a dose of 40 mg / day v / o, x 4 consecutive days, similar to VAD. 60-70% of responses were reported. Among the advantages to be indicated are the manageability, no hematological toxicity, usable in older patients or those with bad general condition, alkylating removal.
  • It is recommended in patients who have a contraindication for cytotoxic chemotherapy have a severe pancytopenia or require extensive radiotherapy. It is useful as initial therapy in patients presenting with renal damage.
  • Pulse methylprednisolone: ​​2 g 3 times / week for four weeks at least. Less toxicity than dexamethasone are reported.

Thalidomide

He has shown effect in patients at onset and relapse. Its mechanism of action is not well known, but considered that it involved an anti-angiogenic activity, interference with adhesion molecules and cytokine release.

  • It is administered orally daily (0-200 usual dose 5 mg / day).
  • Has been combined with high-dose dexamethasone has been reported 70-80% of responses. Dose Thalidomide 50-200 mg / day, dexamethasone 40 mg / day / ppr v / o, days 1-4 (or 1-4, 9-12, 17-20) every 28 days.
  • combination with conventional chemotherapy is evaluated. Studies that use MPT scheme (melphalan 4 mg / m 2 v / o, x 7 x month; prednisone 40 mg / m 2 v / ox x 7 days month; thalidomide 100 mg / day, v / or and reported similar results when autologous HCT.
  • The main toxic effects are sedation, constipation, peripheral neuropathy and deep vein thrombosis. No or minimal hematologic toxicity Conventional chemotherapy.

Conventional chemotherapy
GM conventional chemotherapy using alkylating agents prolong survival between 26 and 46 months, with a response in 60% of cases, the response varying according to stage. However, nowadays.

Many patients start with non-alkylating schemes with the aim of eliminating the initial exposure to these drugs, prior to TCH in which high doses of the same is used. The VAD scheme is effective in 60-80% of cases and is non-alkylating scheme of choice in patients for TCH, patients with renal impairment and patients where a quick response is required.

Chemotherapy regimens

  • Melphalan-Prednisone
    ¾ Dose: -Melfalan 0.25 mg / kg / day x 4 days
    -Prednisona: 40 mg / m 2 / day x 7 days
    ¾ Frequency: every 6 weeks
    ¾ Food interfere with absorption of melphalan therefore be taken 30-60 minutes before meals.
    ¾ In the first cycles should be platelet and leukocyte mid-cycle (third week) to assess for response to melphalan (leucopenia and thrombocytopenia light) and increase the dose in the
    sixth week if not occur. Melphalan should not be given if the leukocyte count is less than 2000 x 10 9 / L or less neutrophil 1000 x10 9 / L or platelets less than 100,000 x 10 9 / L
  • In patients with renal insufficiency (creatinine> 177 mmol / L) the initial dose of melphalan should be reduced by 25% to prevent severe myelosuppression. If not, the dose is increased in the next cycles.
  • Treatment should be continued until the plateau phase (paraprotein levels stable for three months in a row) is reached.

Cyclophosphamide prednisone

  • Dose: -Ciclofosfamida 1 g / m 2 / day, 1 dose iv or 250 mg / m 2 / day / days 1- 4 v / or -Prednisona 40 mg / m 2 / day / days 1-7
  • Frequency: every 3-4 weeks
  • Remarks: This would be the treatment of choice in patients with leucopenia and thrombocytopenia to debut. It is recommended that oral cyclophosphamide is taken as a single dose at breakfast. Use cautiously in patients with renal impairment

VMCP

  • Dose: -Vincristina 1 mg / m 2 / IV / day 1
  • Melfalan 6 mg / m 2 / for v / o, days 1-4
  • Ciclofosfamida 125 mg / m 2 / for v / o, days 1-4
  • Prednisona 60 mg / m 2 / for v / or days 1-4
  • Frequency: every 3 – 4 days

Infusional VAD

  • Dose: -Vincristina 0.4 mg / day / IC, days 1-4
  • ƒ -Adriamicina 9 mg / m 2 / day / IC, days 1-4
  • ƒ -dexamethasone 40 mg / day / IV or v / o, days 1-4, 9-12, 17 – 20
  • Frequency: every 4 weeks.
  • Dexamethasone can be used at a dose of 20 mg / m 2 / day

VAD option 1 (bolus)

  • Dose: -Vincristina 0.4 mg / day / IV, days 1-4
    Adriamicina 9 mg / m 2 / day / IV, days 1-4
    dexamethasone 40 mg / day / IV or v / o, days 1-4, 9-12, 17-20
  • Frequency: every 4 weeks
  • Dexamethasone can be used at a dose of 20 mg / m 2 / day

VAD option 2

  • Dose: -Vincristina 2 mg / IV, Day 1
  • Adriamicina 40 mg / m 2 / IV, Day 1
  • dexamethasone 40 mg / day / IV or v / o, days 1-4
  • Frequency: every 4 weeks
  • Dexamethasone can be used at a dose of 20 mg / m 2 / day

DAV (option 3)

  • Dose: -Vincristina 1 mg / IV, Day 1
    Adriamicina 50 mg / m2 / IV, day 1
    dexamethasone 40 mg / day / IV or v / o, days 1-4
  • Frequency: every 4 weeks
  • Dexamethasone can be used at a dose of 20 mg / m 2 / day

Evaluation of response
The following criteria were considered as favorable response:

  • Reduction of 50% or more of the initial concentration of the monoclonal protein in serum or urine (if not present in serum).
  • In cases of non-secretory myeloma is considered 50% reduction of the initial bone marrow infiltration.
  • Improvement of clinical symptomatology.
  • stable without transfusion hemoglobin.
    All criteria must be present, otherwise it will evaluate as unfavorable response

Therapeutic aftercare to conventional treatment

  • Treatment with interferon alfa-2b protein to meet the criteria favorable response to induction chemotherapy was used. May be associated with steroids.
  • Interferon alfa-2b not be used in combination with the initial therapeutic.
  • Before starting maintenance identical to diagnosis up studies will be performed.
  • During treatment the following investigations were carried out:
    ¾ Monthly: CBC and Coombs test itself reticulocytosis
    ¾ Quarterly: ESR, creatinine, calcium, total protein, protein electrophoresis, Bence-Jones protein, anti-IFN antibodies.
    ¾ Semester: medullogram marrow biopsy and
  • Dose Interferon alfa-2b: 3 x 10 6 U / SC three times a week
  • Duration of treatment. 2 years or when presented a relapse or when anti-interferon antibodies are detected If after two years the response is favorable, will continue indefinitely

Hematopoietic cell transplantation TCH autologous

  • Autologous TCH single is indicated in patients younger than 60 years, in first remission without associated diseases. Kidney damage is not absolute contraindication to TCH.
  • The double autologous HCT can be performed in patients who do not obtain complete remission after the first transplant.
  • Peripheral blood is the preferred source of CH, with a minimum of CD34 + cells 2×10 6 / kg.
  • Melphalan should not be used in patients for TCH.
  • The high-dose melphalan (200 mg / m 2) is the conditioning regimen recommended for patients with renal function
    Normal. The dose of 140-100 mg / m 2 are recommended for patients with renal impairment.
  • Not defined the value of using a post-consolidation therapy TCH. Some groups recommend IFN-α (Alone or associated with steroids).
  • The transplant-related mortality (TRM) is 5%, the median survival is about 3 to 5 years and median duration of response is 24-36 months. One plateau is not reached in the PFS.

TCH allogeneic

  • Less than 10% of patients with MM have a donor and an age younger than 55 years to receive an allogeneic HCT.
  • It is indicated as first-line treatment in patients
  • We used different conditioning regimens (ICT + Cfm, Bu + Cfm) with no evidence of superiority of one.
  • The results of non-myeloablative conditioning has been evaluated and reported a lower MRT with myeloablative. However, definitive long-term benefits of non-myeloablative HCT is not yet known. The non-myeloablative HCT has been used as post-autologous HCT consolidation. This strategy is still considered experimental.
  • The procedure-related mortality is high (40-50%), even with non-myeloablative (20%).
  • Peripheral blood is the source of CH preferred by many authors, but is not well defined.
  • It is not intended to use some consolidation therapy post-TCH.
  • Overall survival at 5 years post-TCH is 45-50% and progression-free survival is 34% at 6 years.

Bortezomib
The proteasome is an essential system that degrades many intracellular regulatory proteins of the cell cycle, apoptosis, transcription, cell adhesion, angiogenesis, and antigen presentation.

A proteasome inhibitor, bortezomib’s capable of inducing apoptosis, inhibits in vitro growth and surpasses drug resistance in human myeloma cells, and has shown significant activity in various refractory hematologic malignancies.

It has reported a 30-50% response in patients with refractory MM. The use of bortezomib alone or in combination with other drugs, such as first-line therapy in MM is under active investigation.
Relapse
Almost all patients with MM who respond to treatment, relapse. If relapse occurs more than 6 months after reaching the plateau phase, can reinstate the initial therapy.

However, this response is generally lower than at the beginning and if obtained, is short lived. Therapeutic rescue are indicated both relapse and primary refractory or progressive disease
Relapse criteria
The presence of one of the following:

  • Increased concentration of monoclonal protein in serum (or urine in the absence of serum) ≥ 25% of the nadir reached.
  • Onset of clinical symptoms related to myeloma: bone pain, fractures, transfusion requirements, hypercalcemia, etc.

Treatment of relapsed or refractory myeloma

  • after autologous HCT Relapse: you can offer another second
    TCH if sufficient CD34 + cells available (mortality
    increased by 10%) or allogeneic HCT if you have an HLA identical donor. If not possible second TCH, offer a therapeutic rescue, preferably dexamethasone / thalidomide with or without chemotherapy.
  • Relapse after allogeneic HCT. Donor Lymphocyte Infusion.
  • relapse, progression or resistance to primary chemotherapy.
    ¾ Patients who received melphalan-prednisone: infusional VAD
    ¾ VAD patients who received thalidomide or other rescue scheme
    ¾ Patients who have received several schemes poliqiuimioterapia thalidomide or bortezomib.
    Methylprednisolone ¾: 2 g / IV / three times a week for 4 weeks
    If no response continue 1 g / weekly IV
    Cyclophosphamide-prednisone ¾: can be applied to patients resistant to melphalan in the following doses:
    or cyclophosphamide 200 mg / m 2 v / o, weekly
    Prednisone 50 mg or v / or every other day
    Thalidomide ¾ ​​(200-600 mg / day) with or without dexamethasone (20 mg / m 2 / day on days 1-5 every 4 weeks)
    ¾ CAP: 40 mg -CCnU v / o, Day 1
    -Adriamicina 30 mg / IV day 1 100 mg -Prednisona v / o, days 1-5
    ¾ VAMP-vincristine and adriamycin VAD -Metilprednisolona equal to 1 g / IV or v / o, days 1-5
    -Vincristina VBAP ¾ 2 mg / IV, 1st -BCNU: 30 mg / IV, 1st -Adriamicina: 30 mg / IV, day 1
    100 mg -Prednisona v / o, days 1-5
    (Every 4-6 weeks)
    ¾ Scheme ESHAP

Other therapeutic measures General Care

  • Ingestion of at least 3 liters of fluid every day to prevent kidney failure
  • Maintain physical activity (walking) as the bedridden increases bone demineralization
  • As prophylaxis of infections in the first three months of starting treatment the sulfaprim (2 tablets every 12 hours / three times a week) or IV immunoglobulin (500 mg / kg / month) is recommended
    Treatment of anemia
  • Anemia is present in two thirds of patients at the time of presentation and is more frequent in cases relapse or progression. The slight anemia is common during treatment during chemotherapy. Blood transfusion should be given with caution to patients with high levels of paraprotein because of the risk of exacerbating hyperviscosity.
  • Traditionally symptomatic anemia has been managed with transfusions. In recent years, there is growing evidence of the efficacy of recombinant erythropoietin (EPOr) in the treatment of anemia associated with chemotherapy in patients with MM and other tumors.
  • Dose: 150 U / kg, although lower doses can be used; for example, you 10,000 x 2 or 3 times a week.
  • In cases not improve EPOr anemia with blood transfusions should be used at the discretion of the physician.

Radiotherapy

  • Palliative radiotherapy dose 20-30 Gy should be limited to patients with well-localized pain, unresponsive to chemotherapy.
  • It is not indicated in patients with systemic disease.
  • It is advisable, given the synergistic myelosuppression chemotherapy and radiotherapy, the latter end three weeks before starting chemotherapy. Bifos cough ONAF
  • Long-term treatment with bisphosphonates for all MM patients requiring treatment for the disease, regardless of whether or not have obvious bone lesions is recommended.
  • are equivalent oral clodronate (1600 mg / day or an equivalent dose according to the formulation) and IV pamidronate (90 mg / month). Zoledronate (4 mg / monthly) is equivalent in efficacy to pamidronate.

Hypercalcaemia

  • Hydration saline (unless otherwise contraindicated), at least 2000 mL / 24 hours.
  • Furosemide at intermediate doses; for example, 40 mg every 6-8 hours; after dehydration is corrected. The refractory patients can be treated with high doses of furosemide (80 mg every 2 hours) but under strict medical supervision.
  • Corticosteroids can prednisone (40-60 mg / m 2 / day v / o) or dexamethasone (6-9 mg / m 2 / day IV) or methylprednisolone (30-50 mg / m 2 / day used IV ). Steroids should be reduced and discontinued as soon as possible.
  • Start as soon as possible specific chemotherapy.
  • If the above four measures fail to be assessed bisphosphonates, calcitonin or mithramycin

 

Renal impairment

  • Always keep adequate fluid intake
  • Avoid some imaging studies such as IV pyelogram and barium enema.
  • Use allopurinol (300 mg / day) if hyperuricemia
  • In case of acute renal failure resort to hemodialysis or peritoneal dialysis

Hyperviscosity syndrome

  • Plasmapheresis
  • Start ASAP specific chemotherapy cord compression
  • Radiation dose of 30 Gy
  • Dexamethasone 9.6 mg / m 2 / day, IV.
  • In selected cases, the patient should be evaluated (early) with orthopedics and neurology services to determine if you have surgical indication (corpectomy with bracket)

Coordination with other services
Coordinating with the various services for conducting investigations to diagnose the disease stage and treatment decision will be established.

Income
Patients were entered in the hematology and come from the other hospital, the second hospital level of care and in-hospital consultation.
Consultation
Patients will be followed as outpatients in the consultation of malignant blood diseases hematology department. Chemotherapy is given in the designated for this function in the hospital area. Radiotherapy was applied in the nuclear medicine department

EVALUATION AND CONTROL
Structure

  • Fundamental human resources will be integrated by specialists of Hematology in coordination with the head of protocol.
  • Material resources are available in the hospital for the study and treatment of these malignancies.

Processes
Include all patients in the database service haemopathies.
Results

  • Achieve a higher overall survival of 5 years.
  • Evaluate the overall and disease free survival at 3, 5 and 7 years after completion of treatment.

Information for patients and relatives
On admission he was inform the patient and family about the procedures which will be submitted to make the diagnosis and / or stage or extent of disease. When these procedures involve some risk is information detail patient and family, and consent to the realization of the same request. Completed studies will provide information about the disease, treatment advice, prognosis and follow-up. This information will be made with greater clarity and understanding.

Bibliography
1. Badros A, Barlogie B, Siegel E, et al. Improved outcome of non-myeloablative allogeneic transplantation in multiple myeloma. J Clin Oncol. 2002; 20: 1295-1203
2. Barlogie B, Shaughnessy J, Tricot G, et al Treatment of multiple myeloma. Blood, 2004; 103: 20-32.
3. Barlogie B, Tricot G, Anaissie E. Thalidomide in the management of multiple myeloma. Semin Oncol. 2002; 28: 577-582.
4. Berenson JR, Crowley JJ, Grogan TM, et al. Maintenance Therapy With alternate-day prednisone Improves survival in multiple myeloma patients. Blood. 2002; 99: 3163-3168.
5. Child J, Morgan G, Davies F, et al. High-dose chemotherapy With hematopoietic stem-cell rescue for multiple myeloma. N Engl J Med. 2003; 348: 1875-1883.
6. Kyle RA, Rajkumar. Multiple Myeloma N Engl J Med 2004; 351: 1860-1873.
. 7. Ludwig FE Interferon-alpha treatment in multiple myeloma: meta-analysis of 30 randomized trials Among 3948 patients. Ann Oncol. 2000; 11: 1427-1436.
8. Ma M, Yang H, Parker K, et al. The proteasome inhibitor PS-341 Markedly Enhances sensitivity of multiple myeloma tumor cells to chemotherapeutic
agents. Clin Cancer Res 2003; 9:. 1136-1144.
9. Rajkumar SV, Hayman S, M Gertz, et al. Combination Therapy With thalidomide plus dexamethasone for newly diagnosed myeloma. J Clin Oncol. 2002; 21:
4319-4323.
10. Sanchez M, J Carnot, Fleites E, et al. Surgical treatment of injuries of the spine in patients with multiple myeloma. Rev Cubana Med
2003; 42 (4).

Multiple myeloma signs and symptoms

Multiple myeloma signs and symptoms , Unlike many other types of cancer, myeloma can affect the body in many ways. This is due to the activity of the cell mielomatosa itself and the release of a series of proteins and other chemicals in the micro environment of bone marrow and directly into the bloodstream.

It is very important to remember that not all patients will experience all the complications. Below we describe the symptoms and com¬plicaciones more common in cases of myeloma.

Bone diseases are one of the most frequent in myeloma patients complications. Mielomatosas cells release chemical compounds that activate cells osteoclastic that destroy bone and block the osteoblastic cells, which are normally in charge of repairing the damage caused in the bones.

When this happens the bone is broken until you can regenerate, which leads to bone pain, injuries and even fractures. The middle and lower parts of the back, rib cage and the hips are affected most frequently. Fractures cause more frequently in the vertebrae or ribs.

These fractures may occur with a minor injury or a very moderate pressure and, in the case of the vertebrae fractures can cause collapse of the same, causing pain, loss of height and deviation of the spine.

Multiple myeloma signs and symptomsPain is one of the most common symptoms of patients diagnosed with myeloma and is usually associated with an underlying bone disease.

The effective management of the pain suffered by the patient and its relationship with the quality of life is as important as treatment and critical to combat myeloma in itself.

The pain is very particular in each patient and his treatment will vary, so the medication should point to a relief continued pain whenever possible with the least number of side effects associated with those drugs.

In some cases patients certain benefits have been obtained using complementary therapies such as relaxation techniques, aromatherapy and even hypnosis.

Fatigue The most important part of the treatment of fatigue is merely recognize it as such.

It is important that you mention to your doctor how you feel because there are several things that can be done to address some of the causes of fatigue.

Fatigue has been described occasionally as a vicious, but can break that cycle and allow the patient to manage it effectively. There are a series of things that can make to help you to you yes same or so you help those that you care.

Renal damage Associated with myeloma kidney problems can occur for different reasons. The abnormal production of proteins by cells mielomatosas can damage the kidneys This is especially common in the case of protein Bence Jones.

Other complications of myeloma, dehydration and hypercalcemia and some of the drugs used for the treatment of myeloma and its complications, can also cause damage to the kidney (especially anti-inflammatory drugs).

Anemia and infections In adults, almost all of the red blood cells, white blood cells and platelets are produced in the bone marrow.

Red blood cells contain a protein called hemoglobin that carries oxygen throughout the body. White blood cells are those that help fight infections in the body. Finally platelets are small cells that circulate in the blood and help the blood to clot.

Given that mielomatosas cells displace other cells that are produced in the bone marrow, fewer blood cells occurs. This decline in the number of blood cells can lead to diseases such as anemia or frequent infections.

Anemia, as mentioned above, is a reduction in the number of red blood cells or hemoglobin responsible for the transport of oxygen-containing. It may occur as a result of myeloma or as a side effect of the treatment and produce symptoms of fatigue and weakness.

Low levels of white blood cells do not have why to need specific treatment, but the patient must be alert for symptoms of infection (such as fever, cough and green sputum or pain with urination) and consult your physician at the slightest symptom.

Multiple myeloma clinical trials

New treatments and clinical trials A lot of research is being conducted to find more effective and less toxic treatments. Many of these treatments are under development and some of the most promising are explained below.

However, until the effectiveness and safety of new therapies has been established and demonstrated, are usually only used in cases where the disease has not experienced any remission or patients with relapse after several conventional treatments.

The best way and the most safe to receive a drug or a new treatment is always part of an approved clinical trial. It is important to understand that not all patients are candidates for a new treatment in the development phase, but if the patient is interested in following one of those treatments you will need to discuss it with your specialist.

Clinical trials are planned research involving patients who test new treatments, or compare different types of application of existing treatments. Clinical studies always work under very strict rules that are called Protocol.

All patients taking part in the study are strictly controlled, and the information that is collected through all phases of the study are combined and then analyzed by researchers. The results will help determine which are the best treatments and this way is able to improve the treatment of future patients.

Among the new treatments, one of the most promising is that used a drug called Revlimid. The results of studies that have used REVLIMID ® have been very positive to date by what has already been approved its use.
multiple myeloma clinical trialsOther types of treatment that are being developed are those that include monoclonal antibodies, which are used with the intention to attack the mielomatosas cells without affecting normal cells vaccines which seek to increase the strength of the immune system to attack myeloma; as well as targeted radiation therapy, which aims to eliminate cells mielomatosas with direct application of radiation without affecting other areas of the body.

Many new combinations of drugs, such as for example the CTD (cyclophosphamide, thalidomide and dexamethasone) combined or the combination T-Dex (thalidomide and dexamethasone) are already used. New combinations incorporating VELCADE and REVLIMID to standard treatments are also using.

As for transplants, research right now on the effectiveness of a type of allogeneic stem cell transplant called mini-trasplante, also known as with reduced intensity conditioning allogeneic transplant. It aims to achieve the same effect but with lower than with conventional allogeneic transplantation risks.

Another technique of transplantation is investigating is autologous tandem, which is carried out a second autologous transplant as soon as the patient recovers from the first to increase the level of response and extend to the maximum possible period of remission of the disease.

Since both approaches to treatment are relatively new and have not even evaluated fully, the only way to carry them out is within the context of a clinical trial in a hospital where staff have extensive experience in this type of transplant.

Unfortunately not all new treatments are better than the treatments already existing and proven, so it is essential carried out always intense trials to quite analyze all details of each new treatment.

At the same time, the fact that propose a patient participate in a new clinical trial does not necessarily mean that it is proposing you participate in a new treatment. The study may be testing simply new ways of using already established treatments. In some hospitals, the inclusion of clinical trials in cancer patients is a part of routine practice.

As you are discovering new data on these experimental treatments, his role next to established treatments will be clearer. Eventually, if they prove to be more effective or safer, you can get to replace some of the existing treatments.

New therapeutic advances against multiple myeloma
According to a phase III multi-center clinical trial, led by Dr. Jesús San Miguel, medical director of the University Clinic of Navarra and clinical medicine and translational research at the University of Navarra

The results of the research – 768 patients developed and promoted by the pharmaceutical company Novartis – have been recently published in The Lancet Oncology, one of the journals with the greatest impact in Oncology

The combined use of the drug panobinostat (bortezomib and dexamethasone) conventional treatment in patients with multiple myeloma has shown a significant increase in the rate of disease progression-free survival.

Thus reveal it the results of a multicenter clinical trial phase III carried out 768 led multiple mieloma patients by doctor Jesús San Miguel, medical director of the University Clinic of Navarra and director of clinical medicine and translational research at the University of Navarra. 215 hospitals in 34 countries they have participated in this research.

The findings of the research – which started in 2010 and promoted by the pharmaceutical Novartis – have recently been published in the latest issue of The Lancet Oncology, one of the scientific journals of higher impact specialty.

The conclusions of this clinical trial show a “statistically significant and clinically relevant” 4 months increase in median survival free of disease progression, thus passing from 8.1 to 12 months. The median is the time frame in which continue living half of the individuals studied.

The study has been conducted in patients with multiple myeloma relapsing or relapsed / refractory (that continues to progress during treatment), who were treated with the compound experimental panobinostat (LBH589), combined with bortezomib and dexamethasone.

This therapy was compared in the clinical trial with placebo administration over the same combination of these two drugs.

In the trial phase III, called PANORAMA-1 (PANobinostat ORAl in Multiple MyelomA), LBH589 adding also “produced clinically significant increases in full and almost complete response rates and the duration of response”.

The effect of the panobinostat or LBH589 was observed in all subgroups of patients, including high risk cytogenetic and those in advanced stage of the disease.

Multiple myeloma is still an incurable in the majority of patients, with a high rate of recurrence (cancer returns) and resistance (the treatment stops working) hence the importance of the discovery of new drugs. Patients tend to be older than 60 years, few cases occur in people under 40.

Taking into account that the majority of patients with multiple myeloma relapse and become resistant to treatment, “the new therapies with innovative mechanisms of action are fundamental to continue treating the disease and improve outcomes,” stresses Dr. San Miguel. If approved, LBH589 will be the first anticancer agent in its class (acetylases inhibitors) available for this population.

“The PANORAMA-1 study is the first phase III trial which demonstrated the superiority of LBH589 combined with bortezomib and dexamethasone, against the usual regimen of two drugs in patients with multiple myeloma in relapsed or refractory,” announced the principal investigator of the study.

“These results show that, by adding a new mechanism of action, inhibiting bread-DAC, produced a significant benefit in this patient population”, highlights the specialist.

“The majority of people suffering from multiple myeloma stop responding to treatment or relapse, which sharpens the need for new treatment options,” he points out. “The PANORAMA-1 test results provide strong evidence of the potential impact that could have LBH589 on multiple myeloma community”.

In the view of PANORAMA-1 data, LBH589 received preferential designation from the U.S. Food and Drug Administration (FDA) in May and requested its authorization to the European Medicines Agency (EMA).

Currently there are requests regulatory underway around the world. The FDA priority designation is awarded to treatments that offer major advances in treatment.

The trial scene-1

The PANORAMA-1 trial is a randomized trial of phase III, double blind, placebo-controlled multicenter, for the purpose of registration that was designed to analyze the results of LBH589 administration in combination with bortezomib and dexamethasone, compared with the single treatment with bortezomib and dexamethasone in patients with multiple myeloma relapsing or refractory with in at least one prior treatment failure and relapse.

The primary objective of the test was (SLP) progression-free survival. Overall survival, the key secondary objective of the trial data, require more follow-up. Other secondary endpoints were overall response rate, duration of response and safety.

Multiple myeloma and kidney failure

To measure the population ageing expected an increase in cases of dyscrasia of plasma cells and hence kidney failure associated with the paraproteinemia apneic.

At the time of the diagnosis of multiple myeloma, up to 50% of the patients presented some degree of commitment to renal function. Besides the excretion of light chains, there are other factors responsible for the azotaemia as hypercalcaemia, dehydration and nephrotoxic substance use.

The renal compromise is clearly associated with the high tumour mass and is more evident in patients with more advanced stages of the disease. The presence of renal failure does not modify the response of the tumor to chemotherapy and is not a mortality prognostic factor.

95% of patients recover kidney function in the four months following the diagnosis and only 1% requires permanent renal replacement therapy. In the initial management of patients should be deemed the use of plasmapheresis and chemotherapy in high doses seeking to avoid irreversible renal failure.

In those patients with controlled disease and without significant comorbidity must be considered, if necessary, renal replacement therapy including the kidney transplant.

Renal failure in multiple myeloma is frequent It is present in 20-40% of cases at the time of diagnosis, and is a factor of prognosis. Myeloma kidney and hypercalcemia are the most frequent causes other factors that can contribute are dehydration, hyperuricemia, iodinated contrast and nephrotoxic drugs.
kidney failure
Repeated episodes of hypercalcemia can produce deposits of calcium salts in tissues, especially in those with an alkaline medium such as the kidneys, lungs or the gastric mucosa. We present the case of a 38 year-old man with severe hypercalcemia, acute renal failure, multiple myeloma, metastatic and multiorgan failure calcinocis.

Hypercalcemia occurs in multiple myeloma by increase of bone resorption by osteoclast activation due to an overactive receptor RANK/RANK-L. Renal failure occurs due to injury in the renal tubular epithelium that alters the ability to concentrate urine and sometimes cause epithelial cell necrosis and obstruction of the tubules, being able to produce stasis and calcium deposits in the kidney.The treatment must establish quickly with hydration and therapy antimieloma, including steroids.

We conclude on the need to closely monitor the levels of calcium in patients with multiple myeloma and early start therapeutic measures. Bisphosphonates and more effective therapy in renal failure, are recommended in cases of malignant hypercalcemia used the less nephrotoxic adjusted dose.

Symptoms and diagnosis

The main symptom is bone pain, who have 75% of patients. They may appear in any location but the most frequent are beginners in the vertebral column and ribs.

Other possible manifestations of multiple myeloma are the result of the lack of red blood cells (exhaustion, weakness, palpitations, dizziness) or the disruption of the normal functioning of the platelets (easy appearance of hematomas), bleeding from the nose or gums.

In addition, there may be weight loss, frequent infections, bone fractures without an apparent cause and, occasionally, the emergence of real tumors (plasmacytomas) plasma cells.

80% of patients with multiple myeloma have osteoporosis, osteolysis (when worn and reduce one or more areas of a bone), or bone fractures at the time of diagnosis.

The regions affected most frequently are: skull, vertebral column, ribs, sternum, pelvis and long bones such as the femur. A quarter of patients with multiple myeloma has renal failure at the time of diagnosis.

The diagnosis of multiple myeloma is based on the demonstration of an abnormally high amount of a certain immunoglobulin in the blood or urine and an excess of plasma cells in bone marrow.

This must be done different extractions of blood and bone marrow (via puncture of the sternum or bone from the hip and a syringe aspiration). Urine 24 hours to assess whether the above-mentioned abnormal immunoglobulin is present and in which quantities must be tested in the same way.

Finally, all the bones of the skeleton x-rays must be made to see if they have been damaged by the disease. Other analytical changes common in this disease are increased creatinine (renal failure) and plasma calcium, moderate anemia and plaquetopenia.

These findings are not always diagnosed multiple myeloma. Thus patients with a very moderate increase in immunoglobulins and plasma cells in bone marrow, in the absence of any other data of the data mentioned has a Gammapatía Monoclonal of uncertain significance (GMSI), is a minor of myeloma which represents 70% of the monoclonal gammopathies, which usually remain stable for decades without requiring treatment. The probability of transformation of the GMSI myeloma is 12%, 25% and 30% at 10, 20 and 25 years respectively.

Otherwise minor of myeloma is quiescent myeloma. These patients meet criteria for Myeloma (by the increase of immunoglobulins and plasma cells) but have no other clinical or analytical representation of the disease. These patients should not be treated unless there is a progression of disease progression that usually occurs 2-4 years after the diagnosis.

Multiple myeloma mayo clinic

The Mayo Clinic Cancer Center is the only institution in the world currently pursuing using creations of measles virus to treat cancer. Center has focused on basic science research conducted in the laboratory to therapies today are tested on several tumor types, including glioblastoma multiforme (brain cancer), recurrent ovarian cancer and now multiple myeloma.

The Dr. Ángela Dispenzieri, hematologa and principal investigator of the clinical trial in multiple myeloma in these investigations on measles virus. “We have much hope in that this represents one further step to help our patients.”

To create the measles virus used in these studies, more genes were introduced in the strain of the measles vaccine.

Many types of cancer, including multiple myeloma, expressed in excess a protein, the CD46, allowing them to avoid the immune system to destroy them. The strains of the measles virus laboratory seek this protein and use it as a receiver, through which enter the cancer cell. Entered, the virus spreads, infecting neighboring cells and joining them to kill more cancer cells.

This study is different from the other two open clinical trials because researchers given the strain of the measles virus intravenously, rather than directly to the tumor site. For multiple myeloma, the researchers used a strain of the measles virus that was created to carry an additional gene that encodes the co-transportadora protein of sodium and iodine (NIS).about mayo clinic health system

The NIS is produced by the thyroid, where it attracts and concentrates iodine. This feature of the NIS protein may explode as a target toward which point therapy against cancer because you can concentrate radioactive iodine, and thus provide a way to radiate cancer cells selectively, imaging of tumors and control regression.

Eligible candidates for the study of multiple myeloma will be adults with relapse of myeloma, or if this is refractory (i.e. more than one type of treatment failed). In addition, they should not have received transplant allogeneic (from another person) stem cells, must have previously suffered at least one infection by measles and have received the vaccine for the disease.

In the Decade of the 1970s, it was observed that measles infections caused regression in pre-existing cancerous tumors in children. Although noted on this fact, nothing was done to study the phenomenon until the end of the 1990s when, under the direction of Dr. Stephen Russell, the program of Molecular Medicine of the Oncology Center from May Clinic began to investigate it. The current study and other relevant projects are results of such action.

“The multidisciplinary team and institutional support for research from Vanguard boasts Mayo Clinic are the perfect incubator for the development of therapeutic viruses,” said Dr. Russell. “We have everything you need: from professionals in basic sciences that create and test the strains in the vaccine, to those who determine the best way to make a secure mechanism for biological delivery, and finally, clinicians who understand science and develop guidelines through which it is possible to conduct and properly conduct the study.” Thanks to this outstanding team, we can really concentrate on achieving maximum benefit for the patient”.

The team may used by the virus of measles against ovarian cancer reported with the first tests of anticancer activity, which also demonstrate safety. Now, the team may pass to largest and possibly most powerful viral dose. Essay on glioblastoma multiforme, which opened in the fall, try the security for the treatment of this disease from another strain of the measles virus, which also allows the biological control of the anti-tumour activity.

The team of Dr. Russell also seeks ways to use the measles virus to fight other types of cancer, including the of breast, pancreas, and liver.

Funding for the research came from the National Cancer Institute and the Foundation Harold W. Siebens. Other researchers of the Centro Oncológico de Mayo Clinic who participated in the project on multiple myeloma are the doctors: Gregory Wiseman, Val Lowe, Morie Gertz, David Kallmes, and Mark Federspiel.

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Multiple myeloma treatment options

Myeloma treatment always depends on the characteristics of each patient, their evolution and the degree of involvement of the Agency and medical advances.

Until a few years ago the treatment more common systems to control myeloma were different types of chemotherapy, steroids and high-dose therapy and transplantation of stem cells. However, since relatively recently, have introduced new treatments: thalidomide, bortezomib and lenalidomide (which is an analog of Thalidomide), that are shifting to chemotherapy.

There are also a number of treatments of support that help treat the symptoms and complications that myeloma may cause. These supportive treatments include a group of drugs called bisphosphonates that are used to combat the destruction by myeloma of bone tissue, painkillers that relieve bone pain and also, erythropoietin, suitable for anaemia.

However, before embarking on a particular treatment, both the patient and the medical team must make important decisions regarding the best treatment or best suited to the patient and the application times.speaking-to-doctor-about-myeloma-treatment-optionsThe next sections will focus on some important points of decision making with regard to the treatment and provide an overview of the treatments available both to treat myeloma and to treat their symptoms and complications.

The treatment of multiple myeloma is performed in different phases:

  • Induction treatment (of initial or first line) The initial treatment of patients with multiple myeloma depends, among other factors, age and prognosis.Thanks to substances such as thalidomide, lenalidomide and bortezomib, in recent years have been important advances in the treatment of multiple myeloma.At present, these new drugs are used alone or in combination with others, at different stages of the treatment and they have helped those affected can live longer and better.Currently there are combination therapies for the treatment of multiple myeloma in front, which are used both new drugs combined, and new drugs with one or more of the so-called standard therapies (melphalan, prednisone, doxorubicin, and dexamethasone), and even are investigating along with the bone marrow transplant.The mechanisms of action of Thalidomide made the triple combination of melphalan, prednisone and Thalidomide (MPT) to act more effectively in patients who suffer from multiple myeloma and receive treatment for the first time (first-line therapy) that the double combination (MP) without Thalidomide. Other combinations with three equally effective drugs.
  • Maintenance therapy In patients who respond to initial treatment, the goal is to prolong the duration of remission with the fewest possible side effects. Consolidation or maintenance in multiple myeloma treatment is that is administered once completed the treatment that has obtained remission, partial or total.

Treatment for under 65 years: Patients under age 65, after first-line treatment continues, if the patient has achieved complete or partial remission with intensive chemotherapy and autologous transplantation, which maximized, in a short period of treatment (close to the four weeks with the recovery from the effects of intensive therapy) reduction in tumor mass of myeloma.

Treatment for 65 years or older: In patients over 65 years, after first-line treatment, is often stop treatment and wait if the patient markers remain stable (plateau phase) until once again show signs of activity. This is due to the vitality of the body of the elderly deteriorates after prolonged treatments.

The option to continue with a maintenance dose treatment most casualties of one of the new agents (either with Thalidomide or lenalidomide, bortezomib, combined or not with steroids) for several months or years can be beneficial in the long run.

Given that there are several options for the treatment of multiple myeloma, these can be applied in successive manner. If the therapy applied in the first place has no effect (resistant myeloma), or let it lapse (relapse) following therapies can be tested.

The patient has to find out about the different possibilities, in a way can figure out together with your doctor what is the most appropriate therapy.

The patient should consult all possible treatments that could be adapted to your case, be also interested in the reasons for the proposed treatment and learn about the advantages, disadvantages and possible alternatives with your doctor.

It is also important that the treatment of multiple myeloma suits at all times other derived pathologies (e.g., reduction of the functions of the kidney). There are many more possible treatments, more decisive will be discovering which of all is best suited to each case.

It is possible that the patient may personally weighed the advantages and disadvantages of a therapy different from other patients.

Therefore have to tell your doctor what are the most important factors (for example, a therapy with few reactions adverse, even though its effectiveness be weakened by it, or have less contact with the clinic, for their usual life rhythm is affected the least possible and you can enjoy, for example, planned holidays).

Therapy depends on as well as Comorbidities (e.g. restricted kidney function, a disease of the heart, etc), the age, General conditions of life and other personal circumstances.

Multiple myeloma diagnosis criteria

In Multiple myeloma diagnosis criteria is usually done by chance, since the bone marrow cancer presents few or no discomfort in the early stages. In the majority of patients come to the doctor by a speed very rapid sedimentation, anemia, or frequent infections.

For the diagnosis of multiple myeloma are, first, an x-ray, a magnetic resonance imaging (MRI), a bone marrow biopsy, as well as an analysis of blood and urine. If the doctor suspects that there may be multiple myeloma, can you confirm your suspicion if the following guidelines are given:

  • Smear of bone marrow with more than 10% of plasma cells.
  • Plasma cell infiltration determined histologically.
  • Antibody monoclonal (paraproteins) in blood or urine.
  • Destruction of bone tissue at certain points (osteolysis) or osteoporosis (loss of bone density) observed through the proliferation of plasma cells in the bone cell.

If two of these tests are positive, it means that multiple myeloma can be diagnosed. In addition, the following criteria can contribute to the diagnosis of multiple myeloma:

  • Hemoglobin in the blood
  • Values of calcium and proteins in the blood
  • Low values of Defense proteins

In multiple myeloma bone marrow (examination of a sample of tissue) biopsy is an important part of the diagnosis, since it provides essential information on the composition of the blood and the bone lining. The doctor removes a sample of the iliac crest.

It is necessary to perform an x-ray of the skeleton, since multiple myeloma affects both ribs and the vertebrae and the pelvis and femur. Using the results of the magnetic resonance (RM) the doctor can determine how much the tumor has spread by the bone marrow.

International Research Group publishes updated criteria for diagnosing multiple myeloma

The International Working Group on myeloma (IMWG, for its acronym in English) today announced the update of the criteria for the diagnosis of multiple myeloma. Work outlining the new criteria are published in the journal Lancet Oncology. Multiple myeloma is a cancer of the blood that originates in a type of white blood cell, known as plasma cell.

“Our group is composed of more than 180 researchers on myeloma from all over the world, who updated the definition of multiple myeloma for diagnostic purposes to include validated biomarkers, as well as current clinical symptoms that include high levels of calcium in the blood, kidney failure, anemia and bone lesions, says the lead author, Dr. S. Vincent Rajkumar, hematologist of Mayo Clinic.

Dr. Rajkumar explains that multiple myeloma is always preceded sequentially by two asymptomatic conditions: the monoclonal gammopathy of uncertain significance (MGUS, for its acronym in English) and quiescent multiple myeloma (SMM, for its acronym in English).

However, since both the monoclonal gammopathy of uncertain significance and quiescent multiple myeloma are asymptomatic, in the majority of patients not diagnosed disease but until organic damage occurs. “The new criteria of the IMWG allow diagnosing myeloma in asymptomatic patients until there is an organ damage, using validated biomarkers that identify those who suffer from multiple myeloma quiescent and are at risk” extremely high “of moving to multiple myeloma”, says Dr. Rajkumar. “These biomarkers related to the inevitable development of clinical symptoms and are important for diagnosis and early treatment, very important thing for patients”.

Dr. Rajkumar said that other updates to the criteria applied in the diagnosis of multiple myeloma include the use of TAC and PET-TC scans to identify bone lesions that allow to establish a more exact diagnosis and intervene before fractures or other serious problems arise. “We believe that the new criteria shall rectify the impossibility of using the considerable advances in therapy for multiple myeloma until an organic damage. Now, in some patients start therapy early in the course of the disease”.

Dr. Rajkumar notes that several researchers conducted primary research that made it possible to update the criteria and is very grateful for the support of patients and advocates of patients whose stories and opinions provided the impetus for this change in the paradigm.

Multiple myeloma blood test

Blood tests. The laboratory analysis of blood may reveal protein produced by myeloma cells M. Other abnormal protein produced by myeloma cells called beta 2 microglobulin can be detected in the blood and give to your tracks medical about the aggressiveness of the myeloma.

Also blood tests to examine his renal function, blood cell counts, levels of calcium and uric acid levels can give your tracks the doctor about his diagnosis.

Blood cell counts The complete blood count is a test that measures the levels of red blood cells, white blood cells and platelets in the blood. If there are too many myeloma cells in the bone marrow, the levels of some of these blood cells are low. The most common finding is tallying low red blood cells (anemia).

Quantitative immunoglobulins This test measures blood levels of different antibodies. There are several different types of antibodies in the blood: IgA, IgD, IgE, IgG, and IgM. The levels of these immunoglobulins are measured to determine if somebody is abnormally high or low. In multiple myeloma, a type level may be high while others are low.

Electrophoresis Immunoglobulin produced by myeloma cells is abnormal because it is monoclonal (same antibody). A test called electrophoresis of proteins in serum (SPEP), measures the amount of immunoglobulins in the blood and can detect a monoclonal immunoglobulin.

Then, another test, such as immunofixation and immunoelectrophoresis, is used to determine the exact type of abnormal antibody (IgG or otherwise). The first step to make a myeloma diagnosis can be find a monoclonal immunoglobulin in the blood. This abnormal protein is known by several different names, including immunoglobulin monoclonal antibody, protein M, M peak and paraprotein.

Immunoglobulins are formed of protein chains: two long chains (heavy) and two shorter chains (light). Sometimes the kidneys excrete in the urine protein M. portions This protein in the urine, known as Bence-Jones protein, is the part of the immunoglobulin light chain called.

The tests used to find a monoclonal immunoglobulin in the urine are called protein in urine (UPEP) and urine immunofixation electrophoresis. More often, these tests are done on urine collected over 24 hours, not just a routine sample.

Free light chains (FLC) This test measures the amount of light chains in the blood. A high level represents a possible sign of myeloma or light chain Amyloidosis.

This test is most useful in rare cases of myeloma in which is not M through the SPEP-protein. Since the SPEP measures (total) intact immunoglobulin levels, you can not measure the amount of free strings.

This test also measures the rate or ratio of free light chains, which is used to see if one type of light chain is more common than the other.

There are two types of light chains: kappa and lambda. Normally, are present in equal amounts in the blood, giving a rate of 1 to 1. If one type of light chain is more common than the other, the index will be different, what may be a sign of myeloma.

Beta 2 microglobulin Beta 2 microglobulin is another protein produced by the malignant cells. Although this protein alone does not cause problems, it may be a useful indicator of the prognosis of the patient. High levels indicate that the disease is more advanced and maybe a worse prognosis.

Biochemical test of blood Levels of urea nitrogen in the blood (BUN) and creatinine (Cr), albumin, calcium levels and other electrolytes will be verified.

BUN and creatinine levels indicate what as well functioning kidneys. An increase in levels means that the kidneys are not working well. This is common in people with myeloma.

Albumin is a protein that is found in the blood. Low levels can be a sign of a more advanced myeloma.

Calcium levels may be higher in people with advanced myeloma. High levels of calcium can cause serious symptoms of fatigue, weakness and confusion.

The levels of electrolytes, such as sodium and potassium may also affect.

Common medical tests and clinical analysis for confirm the diagnosis of myeloma

Blood count to determine to what degree is affecting myeloma normal production of blood cells the lower figures may indicate anemia, increased risk of getting infections, and clotting difficulties

Clinical Biochemistry (albumin, calcium, lactate dehydrogenase [LDH], blood urea nitrogen
[BUN], and creatinine) to assess the general State of health and the extension of the Myeloma anomalous concentrations may indicate kidney damage and increase the amount or size of tumors.

Level of microglobulin beta 2 (M-ss2) to determine the concentration of a serum protein that reflects both the pathological activity as renal function elevated concentrations indicate that myeloma is more widespread test help to know the stage of the disease.

C-reactive protein stop an estimate indirectly the amount of cancer cells high concentrations indicate that myeloma is more widespread

Levels of immunoglobulins to define the levels of antibodies to overproduce elevated myeloma cells point to the presence of a myeloma.

Electrophoresis of serum proteins to detect the presence and concentration of various
proteins, including protein M high concentrations indicate that myeloma is more widespread; the test helps to classify disease.

Immunoelectrophoresis (also called with IFE immunofixation electrophoresis) to identify the type of abnormal antibodies that help blood to classify disease.

Freelite analysis of light chains free serum to measure the light chains of
immunoglobulin concentrations and/or abnormal proportions are running to the presence of a myeloma or a similar disease.

Multiple myeloma stem cell transplant

Multiple myeloma stem cell transplant , the patient receives high doses of chemotherapy to destroy cells in the bone marrow (including myeloma cells).

Then the patient receives blood-producing new and healthy stem cells. When stem cell transplants were developed for the first time, the new stem cells come from bone marrow and therefore was known as bone marrow transplantation.

Today, stem cells are obtained more often than blood (peripheral blood stem cell transplantation).

Stem cell transplantation is commonly used to treat multiple myeloma. Before the transplant, medication treatment is given to reduce the number of myeloma in the patient’s body cells

Autologous transplants (autologous transplants)

In a stem cell transplant, own stem cells from the patient are extracted from their bone marrow or peripheral blood before the transplant.

Cells are stored until they will need for the transplant. Then, the person with myeloma receives the treatment, such as high-dose chemotherapy, sometimes with radiation to kill cancer cells.

After treatment, the stored stem cells are infused into the patient’s blood.

This type of transplant is a conventional treatment for patients with multiple myeloma.

However, despite the fact that an autologous transplant can make myeloma disappears for a while (even years), this does not cure the cancer, and eventually myeloma returns.

Some doctors recommend that patients with multiple myeloma undergo two autologous transplants, apart for six to 12 months. Call this method transplant tandem.

Studies show that this can benefit more patients than when a single transplant. The disadvantage is to cause more side effects and therefore carries a higher risk.

Transplants allogeneic (Allo-transplants)

In an allogeneic transplant of stem cells, the patient receives blood from another person (a donor) stem cells.

The best treatment results occur when the donor cells are very compatible to the type of cell of the patient and the donor is a close relative, such as a brother or a sister.

Allogeneic transplants are a higher risk compared to auto transplants, but can better fight cancer. This is because

transplanted cells (from the donor) may, in fact, help destroy myeloma cells. Graft-versus-tumor effect is this called.

However, in studies conducted in patients with multiple myeloma, who received allogeneic transplants often said worse in the short term than those receiving autologous transplants.

At present, allogeneic transplants are not considered a treatment for myeloma, although they can be as part of a clinical study.

Side effects Multiple myeloma stem cell transplant

The first side effects of transplantation of stem cells are similar to the side effects of chemotherapy and radiation, only that they are more serious.

One of the most serious side effects is low blood counts that could cause risk of serious infections and bleeding.

The most serious side effect of the allogeneic transplant known as disease of Graft-versus-host (or GVHD,) for its acronym in English that occurs when new immune cells (from the donor) identify patient tissues as foreign and therefore attack them. The GVHD can affect any part of the body and may endanger life.

In the stage II and III multiple myeloma, treatment should always include chemotherapy. In this advanced type of multiple myeloma, chemotherapy is important to avoid, or at least delay, the rapid advance of tumor.

In multiple myeloma stage I with slow course, the side effects of chemotherapy would trigger more problems than the disease itself. Then it is possible, under certain circumstances, renounce the chemotherapy at the beginning.

Stem cell transplantation

When the patient’s general condition allows it, you can use high doses of chemotherapy followed by transplantation of blood stem cells.

In these cases, the patient receives high doses of chemotherapy drugs. These high doses destroy all the cancer cells, but also cells (so-called stem cells) blood-forming bone marrow (and, therefore, the immune system).

Then the patient receives stem cells from blood, with which you can create a new system slowly. This treatment of myeloma is very risky and only is possible if the patient is in good general health.

A new molecule allows an increase in umbilical cord stem cell transplants
Researchers of the Institute of research in Immunology and Cancer (IRIC) at the University of Montreal, Canada, announced in the journal Science the discovery of a new molecule that allows you to multiply the stem cells in umbilical cord blood unit. Umbilical cord stem cells are used for transplants to cure a number of diseases related to blood including leukaemia, myeloma and lymphoma.

Multiple myeloma stage 3

Multiple myeloma stage 3 , Laboratory tests will determine the extent of the cancer, which is classified in stages. The classification of the stages is complicated and is based on the levels of protein, calcium, renal function, and the presence of cancer in the bone.

Your doctor will order blood tests to detect anemia, which is a low level of red blood cells. The disease causes anemia when plasma cells accumulate in the bone marrow and prevent the normal production of red blood cells.

Blood tests also detected if blood has unusually high levels of protein, a sign of large amounts of immunoglobulin made by the cancerous plasma cells. Your doctor could ask for urine samples for 24 hours to scan them for excessive amounts of protein.

Your doctor may order x-rays of the long bones, skull and chest to help confirm the diagnosis and detect bone weakness (in the bones). They will also make you a bone marrow biopsy to confirm an abnormally high level in the plasma cells.

This procedure is done under local anesthesia in the doctor’s office. A long needle is used to remove a small amount of bone marrow and examine it under a microscope. Normally, the plasma cells represent less than 50% of the cells in the bone marrow.

However, in patients with multiple myeloma, this percentage increases of 10 to 19%. Multiple myeloma is diagnosed if a bone marrow biopsy shows more than 30% of plasma cells.

In multiple myeloma the doctor determines the stage of the cancer diagnosis. Multiple myeloma is divided into the following stages depending on the mass of the tumor cells (myeloma cells mass):

  • Stage I: cancer cells have spread through the body and symptoms of the disease may not have.
  • Stage II: a moderate number of cancer cells have spread through the body.
  • Stage III: a large number of cancer cells have spread through the body. Could also have anemia as a result of a decrease in red blood cells; high levels of calcium in the blood due to damage to the bones; more than three bone tumors; or a high level of M protein in the blood, a sign of the extent of the tumor in the body.

Duration Around 15% of patients die within the first three months after the diagnosis. In the majority of cases, the disease progresses slowly for two to five years, followed by a short period where symptoms worsen quickly.

Prevention It might be possible to prevent some cases of multiple myeloma to avoid exposure to radiation, benzene or pesticides.

Treatment If you don’t have any symptoms, treatment could be delayed until the disease progresses, depending on their general State of health. Initial treatment may include:

  • Four to six applications of chemotherapy: are supplied in a period of one to two years. With treatment, around 70% of the patients improve and there is no sign of the disease in about 10% of cases.
  • Intravenous (into a vein) injections of bisphosphonates: this class of drugs quimioterepeuticos, often supplied once a month, can reduce the risk of fractures in the bones and improve survival in case of myeloma.
  • Chemotherapy: recently several types of medications have been developed quimioterepeuticos which has been proven are effective in the treatment of multiple myeloma. Cancer specialists experienced in the treatment of myeloma may select the most appropriate treatments once made the diagnosis of myeloma
  • Radiation therapy: to treat the tumors in the bones.
    Intravenous injections of immunoglobulin: to prevent serious infections.
  • Bone marrow transplant: this can help patients under age 65, especially if this treatment applies just the disease appears.

It is not clear whether any of these therapies can help cure patients, but often they can control the disease for years.

Prognosis and evolution of multiple myeloma depends on the stage of the tumor. Proper treatment can positively influence the evolution of the disease. Life expectancy increases if the treatment slows the progression of multiple myeloma or reduces tumor.

In addition, it is possible to treat the symptoms caused by multiple myeloma, so increase the quality of life of the patient. A cure is not possible, but the period without discomfort can be very long (though always relapse occur). If it is not, the multiple myeloma can be extended by all of the bone marrow.

The tumor may be the cause of the process of bone degeneration that occurs in the spontaneous fractures with vertebral collapse. Multiple myeloma can also affect the kidneys. Antibody deficiency characteristic of multiple myeloma makes patients extremely vulnerable to infections. Due to the damage of bone marrow, it may also occur bleeding due to lack of platelets in the blood and clotting factors.

Multiple myeloma monitoring plays an important role after the treatment. During this, revisions are made at regular intervals.

These tests usually do a physical examination of the patient, various blood tests and x-rays.

With the test of bone density in the lumbar area of the spine and the femur, the doctor can determine if there is loss of bone density and marked as is.

Monitoring serves to detect early and treat relapses of multiple myeloma and the damage caused by the disease.