Multiple Myeloma Diagnosis and Treatment

Multiple myeloma diagnosis and treatment - Multiple myeloma: Among cancers, the leader in the number of registered drugs this year was multiple myeloma — bone marrow disease in which there is reproduction of malignant plasma cells. Cells, maturing b-lymphocytes in response to infection and produce antibodies.
Multiple Myeloma Diagnosis and Treatment

In malignization they divide uncontrollably, produce non-functional antibodies, and the patient has an increased number of infections, bone fragility, kidney problems, increase the level of calcium in the blood. The disease is incurable and is very versatile, but although modern medicines help to extend the life from 3-4 to 5-7 years, eventually the disease is still out of control and carries more than 75,000 lives a year.

New drugs, 2015: 2017
This year it was approved 4 medication for the treatment of multiple myeloma: two antibodies and two small molecule. All four of the drug shows a very severe patients, not responding to treatment with standard therapy methods.

  • Darzalex antibody (daratumumab) Janssen Biotech (a subsidiary of Johnson & Johnson) directed against targets CD38 on the surface of transformed cells, and it became the first drug — antibody for the treatment of this disease. Have 30-36% of patients taking the drug, decreased tumor burden, the annual survival rate was 65%.
  • Empliciti antibody (elotuzumab) of the companies BMS and AbbVie are directed against SLAMF7 protein, which is also located on the surface of myeloma cells. Binding of antibodies causes activation of cells of the immune system of the patient, which destroy abnormal cells. The addition of antibodies to the standard drugs — Revlimid (lenalidomide) and dexamethasone — delays disease recurrence by an average of 5 months and increases the response rate to therapy from 66% to 79%.
  • Two other drug Farydak (panobinostat, Novartis International AG) and Ninlaro (ixazomib, Takeda) has been well-known mechanisms: the first (inhibitor of histone deacetylase) affects proteins that bind DNA, thus regulating the cell cycle, the second (proteasomal inhibitor) affects the destruction of unneeded cell proteins, which consequently accumulate in the cell, which leads to her death. Both drugs also help to extend the time to disease progression.

Multiple Myeloma Diagnosis and Treatment

Diagnosis: The pain of the bones or back and fatigue that lasts more than two to four weeks in an older person, despite symptomatic treatment, should give further evaluation for multiple myeloma and several other conditions. These patients should consider vitamin D deficiency, hiperparatiroidisme, polimialgia rheumatic and metastase bone. Count the full blood, ESR, a panel of chemical, the level of serum electrophoresis and urine, x-ray, and the level of vitamin D can help in the differential diagnosis.

The diagnostic criteria for prevention (asymptomatic) multiple myeloma is the level of protein in the serum of 3 g / DL (30 g / l) or more, 10 or more percent of the plasma cells of the bone marrow and no organ or tissue from the breach (that is, without Damage on the end, including the bone damage) or symptoms. Diagnostic criteria for multiple myeloma symptoms is a protein of M (serum or urine), bone marrow the bone marrow or plasmacytoma, and disease myeloma - a violation of the organ or tissue. Patients with multiple myeloma symptoms (e.g., The disadvantage that can not be explained, weakness, back pain, proteinuria, anemia, renal failure, recurrent infections, peripheral neuropathy) should be skanirovaniya by electrophoresis of serum and protein urine.

Is also recommended that serum and protein imunofiksasi in the urine, because imunofiksasi can be diagnostic, even with the pattern elektroforetik normal or non-specific. Strips for urine analysis is not sensitive to the protein Bencing and protein electrophoresis of proteins and imunofiksasi recommended for all patients with plasma cells diskrasia. Analysis aspirat bone marrow should be performed on patients who have a serum that is not normal or a urine protein and may need some samples, because the results can be prominent. Table 2 shows the abnormalities of the diagnostics related to multiple myeloma.

Treatment: Although some patients with myeloma multi does not require treatment, the instructions of the oncologist recommended to all patients. Patients with myeloma multiple (asymptomatic) should not undergo treatment. Before this, treatment has no effect on death and can increase the risk of acute leukemia. Three groups prognostik (with the average time to progress to 27, 93, or 228 months) can be determined based on the percentage of plasma cells of the bone marrow and the amount of monoclonal protein. Patients with multiple myeloma dangerous need to monitor laboratory tests every three to four months.

Transplants of stem cells autologous (twice) is the standard treatment for patients with multiple myeloma symptoms the younger than 65 years and for patients-elderly patients who are physically able to undergo treatment. Patients receiving therapy with a dose of chemotherapy high have median survival for 68 months. The protocol of the induction often use vincristine [Vincasar], doxorubicin [Adriamycin], and dexamethasone or dexamethasone and thalidomide (Thalomid) before therapy to prevent myelosuppression from stem cells. Patients who are not candidates for therapy generally receive melphalan (Alkeran) and prednisolone (Prelone) with or without thalidomide for initial therapy.

Patients may experience remission from the treatment of second major; however, relapse natural is common with multiple myeloma. Bortezomib (Velcade) and thalidomide protease inhibitors and lenalidomide its analogs (Revlimide) has been proven useful; clinical Trial ongoing. Family doctors need to be aware about the side effects of thalidomide (for example, drowsiness, neuropathy, thrombosis of the deep veins). Neuropathy Thalidomide is not always reversible and may require discontinuation of therapy. With new treatments, survival for five years in patients with multiple myeloma is currently approaching 33%, and the survival median is 33 months.

The emergence of new means of treatment of oncological diseases with different mechanisms of action is always a big help to patients and doctors, because cancer cells are subjected to selection, evolyutsioniruet and become resistant to lethal effects for them. Therefore, patients have to try several types of therapy, and each increase in a few months can give years of life. These drugs are already available in Israel as second-line treatment of multiple myeloma.