Erythroid myeloma is a cancer of the hemopoietic system, which is characterized by the occurrence of tumours of the bone marrow plasma cells. The incidence in different countries varies from 1 to 4 cases per 100 thousand of population per year. Men suffer more often than women.
Multiple myeloma mainly affects elderly people. 97% of patients are over the age of 40. The disease almost never occurs, except for a few exceptions among people up to 30 years of age.
Erythroid myeloma causes are not yet known. Risk factors that increase the possibility of the disease occurrence, are known:
Multiple myeloma is asymptomatic on the early stage. There can be no symptoms during first 5-15 years after the pathological process will start. Number of plasma cells remains normal in the bone marrow.
Following symptoms can be observed during this period:
Then the developed clinical stage starts, which is manifested by the symptoms of various organism structural damage. The following symptoms are differentiated:
The syndrome of bone pathology. There is a triad of symptoms - pain, fractures and tumours. The first to suffer are the flat bones (pelvis, ribs, sternum, skull) and then followed by the spine. The last ones are the long bones. A characteristic feature of the pain syndrome, which occurs among 90% of patients, is its abatement in the case of bed rest. Pain increases with movement and percussion (rapping).
The hematopoietic system damage. Anemia or low levels of hemoglobin and red blood cells, develops and is clinically manifested by the skin pallor, tachycardia, shortness of breath during exercise.
Syndrome protein pathology is manifested by the pathological overproduction of immunoglobulins (antibodies) and immunoglobulin light chains (Bence-Jones protein).
Renal disease syndrome. Nephropathy develops among 80% of patients with multiple myeloma at its different stages.
It manifests itself in three syndromes:
The syndrome of visceral disease. Enlarged liver and spleen, heart failure, pleural effusion, symptoms from the gastrointestinal tract (nausea, diarrhea, loss of appetite).
Secondary immunodeficiency syndrome. Reducing the production of normal antibodies leads to inhibition of the immune system. The result is frequent infections. The first to suffer are the kidneys, urinary tract, respiratory system.
Hyperviscosity syndrome is aconsequence of the increased protein content in the blood. It is manifested by the impaired vision, coordination, headache, numbness in the limbs. Trophic disorders of the skin of hands and feet are also possible.
Neurological syndrome is a result of the dura mater infiltration by the plasma cells.
The symptoms are:
Hypercalcemic syndrome. The calcium level in the blood is increased among 30% of patients. This is a consequence of its "wash-out" from the bones.
The clinical picture reveals the suspecting multiple myeloma, including the changes in the blood (hemoglobin low level, an increased calcium level) and in urine (proteinuria).
The further instrumental and laboratory researches are done to verify the diagnosis:
Sternal puncture is the main method of the diagnosis during which bone marrow is aspirated from the sternum. The number of plasma cells is greater than 15%. The younger the cells, which form the basis of the tumour, the worse the prognosis.
Radiography helps to detect osteoporosis and the areas of osteolysis. At the first stage of multiple myeloma changes while radiography may be missing.
Electrophoregram of the serum proteins is done to determine paraprotein with help of the immunoelectrophoresis. The method allows setting the amount of tumour mass and determining the stage of the disease.
Multiple myeloma can be treated with help of surgery as well as with the help of conservative therapy. Conservative therapy is used much more often.
Chemotherapy is the main treatment method, when the medications which block the tumour mass growth are prescribed. Chemotherapy helps to significantly increase the life of patients. New drugs are constantly appearing and their different combinations are used for the prognosis improvement.
Stem cells transplantation. They may be taken from the bone marrow (bone marrow transplantation), or peripheral blood. Allotransplantation (from a donor) and autologous transplantation (own stem cells) are distinguished. The patient is administered intensive chemotherapy with high doses of drugs and radiation therapy to destroy the bone marrow cells before the surgery.
Only allotransplantation can be a good chance to ensuring the patient’s complete recovery, as the autologous transplantation is just a temporary solution. It should be added though that allotransplantation is accompanied by the certain complications such as high price, high post-surgery risks, and difficult search for of a suitable donor.
Radiation therapy is used just as a palliative treatment. It allows reducing some of the symptoms of the disease, making it easier for the patient the live the rest of life.
Symptomatic therapy is done parallel with the basic treatment (pain relief, control of anaemia and renal failure phenomena, support of the function of other organs).
If not treated, the median survival of patients with multiple myeloma is only 6 months after diagnosis. This means that 50% of patients die within this period.
Through the development of effective treatment methods it is possible to significantly extend the life even for the patients with stage 3 of the disease.
Prognosis is significantly affected by the age of the patient, presence of renal insufficiency, the blood level of β2-microglobulin, level of the M-component in the blood and urine.
The prognosis depends significantly on the stage of multiple myeloma. If, after the initiation of treatment at the first stage the average life expectancy is 5.5 years then on the third stage it is 2.5 years.
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