Diagnosis and treatment of Multiple Myeloma
Multiple Myeloma is a malignant disease caused by an uncontrolled increase of plasma cells. Plasma cells form a subset of white blood cells, their job is to produce proteins called antibodies. Under normal conditions, antibodies play an important role in the body’s defense system against various microbes. Because immunity against various microbes is required, various types of antibodies must be present in the blood. The malignant plasma cells that occur in Multiple Myeloma are called myeloma cells. Myeloma cells produce only one type (this is called monoclonal) and abnormal antibody. These cells proliferate mainly in the bone marrow, and sometimes appear as tumors in the bones or other parts of the body. Great advances have been made in the treatment of Multiple Myeloma in recent years.
Symptoms of the disease
Multiple Myeloma usually causes high sedimentation. The diagnosis of Multiple Myeloma is sometimes made in a person with high sedimentation by investigating the cause. Sometimes, when the causes of some symptoms of the disease are investigated, it is possible to make the diagnosis. Delayed diagnosis can cause problems. Some symptoms of the disease are as follows:
1. Anemia, anemia
All blood cells are produced and mature in the bone marrow. Red blood cells (red blood cells, erythrocytes) carry oxygen through the substance called hemoglobin in them. Low hemoglobin is called anemia. This may cause problems such as fatigue, weakness, dizziness, and shortness of breath. In this disease, besides red blood cells, a decrease in other blood cells can also be seen. susceptibility to infections if white blood cells (white blood cells, leukocytes) are reduced; Bleeding may occur if blood cells called platelets are reduced.
2. Infection
Normal plasma cells produce various antibodies against microbes, providing the body’s resistance against infectious diseases. In myeloma patients, myeloma cells produce only one antibody, what we call a “monoclonal protein.” In myeloma, this antibody is most commonly of the IgG, IgA, or light chain type. The level of monoclonal antibodies in the blood is measured and is also used in the follow-up of the disease. Because monoclonal antibodies cannot prevent infections, myeloma patients may experience frequent infections or have severe infections. In addition, as mentioned above, if leukocytes are also reduced, the risk of infection increases.
3. Bone disease
Multiple Myeloma causes bone damage in most patients. Myeloma cells both increase the activity of cells called osteoclasts, which dissolve bone tissue, and reduce the work of cells called osteoblasts, which form bone tissue. Thus, myeloma cells cause osteoporosis, pain and fractures may occur in the bones. Even fractures and collapses in the spine bones can sometimes even cause paralysis. X-ray, computed tomography and magnetic resonance tomography are used in the examination of bones, depending on the patient’s problems.
4. Pielet failure
Antibodies consist of heavy and light chains. Myeloma cells produce free light chains in some patients, which can block the kidneys and eventually lead to kidney failure. The level of free light chains in the blood and the amount of light chains in the urine are measured by biochemical methods.
Complications of the disease
Multiple Myeloma, as mentioned above, can create problems resulting from anemia, infections, weakened bones and damage to the kidneys. Apart from that, Multiple Myeloma can lead to the disease called amyloidosis. There are several types of amyloidosis. AL amyloidosis is the type of amyloidosis that occurs with the accumulation of free light chains made by abnormal plasma cells in various organs of the body. Some patients may develop amyloidosis without myeloma. AL amyloidosis can occur in any organ, but most commonly it damages the kidney, heart, or liver. The most common symptoms of AL amyloidosis are fatigue, weight loss, heart failure, shortness of breath, or edema (colds in the feet). Although it is not easy to diagnose AL Amyloidosis, it is vital that the diagnosis is made in a timely manner and treatment begins without delay.
Diagnosis and treatment of the disease
Major advances in the treatment of Multiple Myeloma in recent years have positively and significantly affected the life course of this disease. As large-scale research continues, new treatment protocols and new drugs also represent a constant source of hope in this disease.
In the diagnostic phase, some biochemical studies are done in blood and urine, the condition of the bones and myeloma cells in the bone marrow are examined. Myeloma cells show different characteristics in different patients. Examining these features with the methods called FISH (Fluorescence in situ hybridization) gives important information about the course of the disease.
The treatment is applied by considering the age, physical condition, organ functions and personal preferences of the patient. Some drugs under the name of “New drugs” used in the treatment and stem cell transplantation (bone marrow transplantation) have provided much more successful results in this disease compared to the past, and increased the life expectancy of the patients.
Multiple Myeloma is the most common stem cell transplant (bone marrow transplant) disease in the world. While stem cells were taken from the bone marrow in the past, this method has been gradually abandoned (but the name remains historical), because stem cells are collected from the blood, not from the bone marrow, but from the blood, simply and easily for the patient after a special drug treatment, without the need for surgery. After a few cycles of chemotherapy, autologous stem cell transplantation is targeted in patients with suitable age and organ functions. After the stem cells are collected, high-dose therapy is administered and the stem cells are returned to the patient intravenously. With a low risk of complications, this treatment significantly increases the response rate, quality of response and duration of response in Multiple Myeloma.
In patients who cannot undergo stem cell transplantation, treatment protocols including new drugs are applied.
The response of myeloma to treatment is evaluated according to the quality of the response. There are many details of this evaluation, so in our brief introduction on this page, we touch on the most important points of the evaluation:
Partial response: The amount of monoclonal protein in the blood drops below 50% of the baseline value after treatment, and the amount of monoclonal protein in the 24-hour urine decreases.
Very good partial response: A decrease in the amount of monoclonal protein in the blood below 10% of the baseline value after treatment and the amount of monoclonal protein in the 24-hour urine reduced to 100 mg post-treatment
Complete response: Monoclonal protein in both blood and urine can no longer be seen even with the sensitive method of immunofixation.
A complete response usually significantly prolongs control of the disease and, if it will relapse, the time to disease relapse.
If the disease relapses, there are drugs and drug combinations effective in myeloma that can also be used in this case. In these cases, myeloma can be seen as a chronic disease, a disease that can be treated again when necessary. The goal is to prolong the life span and maintain or increase the quality of life.
Supportive treatment
Multiple Myeloma is a disease in which supportive treatment is important. Supportive treatment is of great importance especially in bone disease caused by myeloma, in the prevention and treatment of infections, in neuropathy, thrombosis (clot) prophylaxis and in the treatment of various problems related to Multiple Myeloma.
