Treatment of multiple myeloma in Germany
Multiple myeloma is a malignant tumour that occurs as a result of differentiated B-cells (plasma cells). The disease is found in 2-3 cases per 100,000 of population per year.
Men suffer one and a half times more often than women. Negroid race representatives are under higher risks while multiple myeloma is not as common among the Japanese and Chinese.
Causes of Multiple myeloma
Etiology of the disease is not yet established. Only few risk factors of the development of the disease are known:
- Ionizing radiation. People who work in the sphere of atomic industry are under high risk of the developing this kind of cancer. Studies show that Japanese people who survived the atomic bombing in 1945 are also at high risk of multiple myeloma possibility.
- Age. Only 2-3% of patients are younger than 40. The danger of multiple myeloma is 10 times higher in people over the age of 80 in comparison with people who are 50 years old.
- Hereditary background. The role of the genetic factor is not proved, but there are cases of multiple myeloma affecting families.
Symptoms of Multiple myeloma
The disease occurs immediately. The first symptom can be:
- Pain in the bones or bone fracture
- Decreased urine amount
- Weakness, headache, dizziness episodes
- Nasal and gingival bleeding
45% of the patients who were just diagnosed with the multiple myeloma have renal dysfunction. For 15% of patients, renal dysfunction manifests itself in oliguria (reduced urine excretion) and requires dialysis.
80% of patients with stages 2 and 3 of multiple myeloma are observed with having radiographic signs of bone disease. 50% of patients have osteolysis (detriment of the bone tissues).
Calcium level is increased in the blood, which can be proved by the following symptoms:
All the organs are involved in the pathological process one way or another. The symptoms are connected and often experience overall damage such as:
- Effects of chronic heart failure (swelling of the legs, shortness of breath)
- Enlargement of the liver and spleen - is observed among 15% of patients in the initial stage of the disease, and up to 30% of patients experience this for the prolonged course of illness
- The study of the fundus reveals signs of retinopathy
- May result in deteriorated respiratory system (pneumonia, pleurisy)
Hence multiple myeloma significantly lowers the immune system. The cause of death for most patients are infections or kidney failure.
Multiple myeloma - Diagnostics
Main methods of multiple myeloma diagnostics are:
- Sternal puncture (bone marrow aspiration form the sternum)
- Blood serum test for the detecting of the monoclonal antibodies produced by malignant cells (using immunoelectrophoresis or immune fixation methods)
- X-ray methods of research with the evaluation of bone status
- Presence of 10% tumour plasma cells in the bone marrow punctate. Only rarely is it normal (punctate of the sternum for the solitary myeloma in 10% of cases). In this case, the material for the study of bone is taken from the tumour foci of extramedullary, osteolytic defects.
- According to the immunoelectrophoresis data, the IgG is more than 3.5 g / 100 ml, and IgA is more than 2 g / 100 ml or excretion of immunoglobulin light chains (proteinuria Bence Jones) with urine is over 1 g per 24 hours.
- X-ray has detected the foci of bone destruction, osteoporosis, reducing the height of the vertebrae and other radiological signs of multiple myeloma.
The first two criteria are main ones. They make an accurate diagnosis possible, however some of the X-ray symptoms may not be seen among certain patients. Also, this symptom is not pathognomonic. Not every case of general osteoporosis shows evidence of multiple myeloma.
The stage of the disease is verified the following way:
Stage 1. Hemoglobin level is less than 100 g / l, the low degree of generating monoclonal protein (IgG is less than 50 g / l G-myeloma IgA is less than 30 g / l for an A-myeloma), calcium level in the blood is normal, light chains of immunoglobulins excretion with urine is less than 4 g per day, X-ray shows the normal rate or not exceeding 1 case of solitary degradation.
Stage 2. Hemoglobin level is 85-100 g / l, the average degree of monoclonal protein production (IgG is 70-50 g / l for G-myeloma, IgA is 30-50 g / l for an A-myeloma), and urinary excretion of immunoglobulin light chains is between 4-12 g per day.
Stage 3. Hemoglobin level is less than 85 g / L, a high degree of generation of monoclonal protein (IgG is more than 70 g / l for a G-myeloma, IgA is more than 50 g / l for an A-myeloma), elevated blood calcium level, urinary excretion of the light chains of immunoglobulins is more than 12 g day, X-ray shows signs of multiple foci of destruction.
Each stage can have a substage A or B, depending on the renal function. If the serum creatinine is normal then multiple myeloma A is diagnosed, if it is elevated, than substage B is verified.
Treatment of Multiple myeloma abroad
Chemotherapy is the main treatment method used to treat the majority of patients who have multiple myeloma. During the therapy medications that block the malignant cells growth are administered. Chemotherapy cannot treat the disease, but the stable remission period can be reached and the patient’s life span can be prolonged for several years.
Stem cells transplantation is an expensive form of surgery therefore it is rarely used, but it offers great results even if the prognosis of the chemotherapy is negative. Autologous transplantation (own stem cells) or allotransplantation (a donor’s stem cells) are used. Stem cells are taken from the bone marrow or from the periphery blood. Before the cells are to be transplanted, the patient’s own bone marrow is destroyed with the help of high doses of the chemotherapy and radiation therapy.
Auto- and allotransplantation have their advantages and disadvantages.
- Autotransplantation is safer in the short term perspective, but it cannot cure the disease completely. Sometimes, two successive transplantations are performed with a gap of 6-12 months of treatment that improves the results of it, but at the same time it can make it more dangerous.
- Allotransplantation gives better results in the long term perspective. It is the only treatment method that in some cases, completely destroys the tumour ("graft-versus-tumour" reaction). But the operation is dangerous for the patient, therefore, it is not a standard of care. There may be incompatible life-threatening complications, including the development of the reaction "graft versus host".
Supportive therapy. The patients are prescribed the pathogenic treatment aimed at the support of the disrupted organism functions and improving the patient’s quality of life. The struggle with the kidney failure, bone demineralization, anaemia and other conditions that accompany multiple myeloma is treated.
Multiple myeloma - Prognosis
The average life span of patients after diagnosis, depends on the stage of the disease:
- Stage 1 - 65 months
- Stage 2 - 44 months
- Stage 3 - 29 months
In recent years there has been a trend towards an increase in life expectancy of patients with multiple myeloma, which is due to the constant improvement of methods of treatment. There are new drugs and regimens that can ensure a stable remission.
Here you can find the cost of treatment for this disease at the German University Hospitals. Leave a request and we will provide a free consultation with a doctor and will start organizing the whole treatment process.
The program includes the following:
- Issuing of an invitation for getting a visa for treatment as quick as possible
- Fixing an appointment at a time convenient for you
- Preliminary organization of a comprehensive examination and discussion of the forthcoming treatment plan
- Arranging transfer from the airport to the hospital and back to the airport
- Provision of interpreting services and services of a personal medical coordinator
- If necessary, assistance in the organization of further surgical treatment
- Provision of a medical insurance against treatment complications covering up to 200,000 euro
- Preparation and translation of medical records and recommendations from the hospital
- Assistance in the subsequent communication with your attending physician, including consultations on repeated X-ray images through the unique medical document management system E-doc