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Multiple myeloma (aka multiple myeloma, Kahler's disease) is a disease that is easy to mistake for a cold at first. Only blood tests reveal what kind of opponent we are dealing with. It is a cancer disease, but when diagnosed in time, it can be controlled. Find out what the causes of Kahler's disease are and what are the symptoms of multiple myeloma.

Multiple myeloma( Kahler's disease , multiple myeloma) - a malignant bone tumor - until recently was diagnosed mainly in the elderly. Unfortunately, the statistics from recent years indicate a disturbing tendency - people under 55 years of age suffer more and more often. In Poland, about 6,000 suffer from multiple myeloma. people, it is slightly more common in men. Annually, 1.5-2 thousand people are registered. new cases. Multiple (plasmocytic) myeloma accounts for 1 percent. all cancers and approx. 10 percent. tumors of the hematopoietic system.

The disease develops in the marrow (mainly in the bones of the spine, skull and ribs), and the lesions are usually disseminated - hence the name multiple myeloma. It is caused by neoplastic growth of plasma cells present in the bone marrow. They displace he althy cells, gradually destroying bones. This process is called cancer osteolysis. Cavities are formed that favor bone fractures. The protein produced by myeloma cells is released into the blood, leading to kidney failure. And because the bone marrow is also responsible for the production of red blood cells and immune bodies, patients are often anemic and prone to infections.

Multiple myeloma: symptoms

Unfortunately, the symptoms of myeloma are not very characteristic - they can be easily mistaken for a common cold, therefore it is detected by chance. At the beginning, it may be low-grade fever, unreasonable weight loss, lack of appetite, night sweats or recurring infections.

There are also bone pains, quite often in the lumbar region, persistent headaches (confused with migraines), a feeling of constant fatigue and general weakness. Over time, more and more apparently unrelated symptoms appear.

Progressive bone destruction promotes fractures (including spontaneous fractures). In the process of bone degradation, calcium is released and enters the blood. This can, as a consequence, lead to disturbances in the work of the brain and heart.Anemia develops as a result of impairment of the number and activity of erythrocyte producing cells.

In contrast, internal organs, such as the kidneys, accumulate insoluble proteins that impair their function. Since the ailments affect various organs, patients with myeloma seek help from many doctors - internists, orthopedists, and rheumatologists. Unsuccessfully. When they finally go to a hematologist (specialist in blood diseases), they can make the correct diagnosis after carrying out the tests.

Worth knowing

Myeloma can be diagnosed earlier thanks to GPs

Myeloma can be diagnosed faster thanks to GPs. This is e.g. in France, where an appropriate algorithm is in place for patients with suspected myeloma. For example, if a patient suffers from anemia, but it does not result from iron or vitamin deficiencies, the primary care physician should refer him to a hematologist, says Prof. Xavier Leleu, Head of the Department of Hematology, Hospital "La Miletrie" in Poitirs, France.

Another example: A patient is struggling with an infection, ESR is elevated, as is the percentage of protein in the urine. If the infection resolves but urine ESR and protein levels remain high, myeloma may be suspected. Then the primary care physician should also refer the patient to a hematologist - says prof. Xavier Leleu. Patients over 60-65 should also be referred to a hematologist. years of age with recurrent, numerous infections and pure bone pains (not articular and bone pains) - adds the expert.

Multiple myeloma: causes

Despite many studies, scientists have not been able to find out the causes of myeloma. The probable ones include, inter alia, a mistake during cell division, as a result of which a single cell mutates, and its offspring are myeloma. There is also insufficient evidence that myeloma can be inherited, even when the disease affects several people in the family. Researchers of this cancer speculate that its occurrence in the elderly may be associated with a reduction in the body's overall immunity and hormonal changes. There is also a theory that the disease may result from the influence of harmful environmental factors on the human body.

Multiple myeloma: diagnosis

Every patient suspected of having multiple myeloma must undergo a lot of tests. First, those that can confirm or exclude the disease are performed. The next ones determine the advancement of the neoplastic process and help to make decisions about the treatment method.

  • Blood analysis - characteristic is accelerated ESR (over 100 mm / h), increased calcium level, highthe amount of abnormal protein, as well as normal protein with the pronounced presence of myeloma-specific antibodies. The high concentration of beta-2-microglobulin also proves the advancement and aggressiveness of the disease. In addition, anemia and a decrease in the number of platelets in the blood are observed.
  • Urine analysis - to assess kidney function. Thus, the levels of creatinine, urea and uric acid as well as calcium levels are tested. The level of the so-called Bence-Jones proteins, which consist of parts of antibodies filtered together with urine. Proteinuria is common in advanced disease.
  • Bone examination - radiological examination and densitometry are the most frequently performed methods. X-ray pictures show characteristic cavities (so-called cheese holes) in the bones, called osteolytic foci. These are the places where myeloma has destroyed the bone. Bone defects are confirmed by densitometry. Sometimes an MRI or computed tomography is also necessary to precisely recognize all bone fragments damaged by the disease.
  • Bone marrow biopsy - allows to reveal the size of infiltrates composed of plasma cells and to determine the percentage of neoplastic cells in the bone marrow. The marrow for examination is usually taken from the sternum.
According to an expertDr. Grzegorz Luboiński, oncologist

Multiple myeloma is a chronic disease of the hematopoietic system. Its first stage is asymptomatic, while the subsequent stages may lead to the development of chronic renal failure, pathological bone fractures and bone marrow failure. Therefore, it is important to quickly identify the disease in order to start appropriate therapy in time. It would be easier if GPs had the opportunity to order basic examinations more often, e.g. ESR.

The mainstay of myeloma treatment is chemotherapy, which destroys the cancer cells in the bone marrow. It can be assisted by autologous transplantation of hematopoietic stem cells, which restores the ability to produce normal blood cells. Some patients, when this treatment is ineffective, use drugs such as thalidomide or bortezomib (Velcade).

Every tenth patient with blood cancer has myeloma. Usually it is detected too late

Multiple myeloma: treatment

Properly selected treatment can stop the development of multiple myeloma and cause the disease - although incurable - to continue for many years as a chronic disease. The choice of therapy depends on many factors, including age, general he alth and the degree to which the disease impairs the patient's life.

The symptomatic form of multiple myeloma is treated with the chemotherapy it hasdestroy cancer cells. In 60-70 percent Oral chemotherapy leads to patients in remission, i.e. to inhibit tumor progression. The combination of appropriate drugs in tablets is selected individually for each patient. In more advanced stages of the disease, chemotherapy is combined with a bone marrow or bone marrow stem cell transplant. To inhibit the process of bone destruction, radiotherapy is often used and an orthopedic surgery is performed to remove a bone fragment affected by the tumor and implant a bone from a donor (from a bone bank) or a special prosthesis.

New drugs with different mechanisms of action continue to emerge. They are the so-called protease inhibitors, such as carfilzomib, ixazomib, monoclonal antibodies (elotuzumab and deratumumab) and HDAC inhibitors (histone deacetylase), which include panobinostat, and the immunomodulating drug pomalidomide. Thanks to these drugs, myeloma is becoming even more chronic, as patients' survival is becoming more and more chronic. longer in Europe, they reach 10 years, and in Poland - 6-7 years). Unfortunately, many of the newest drugs are not reimbursed in Poland yet.

Relief of symptoms is also important in the treatment of multiple myeloma. In severe anemia, patients are given blood, and in milder anemia - erythropoietin. It is a peptide hormone that stimulates the multiplication of red blood cells in the stem cells of the bone marrow. Pain relief patches are effective in severe bone pain. Relieving bone pain is extremely important because it allows you to move for a long time, and this is known to make your bones stronger. Recurring infections are treated with antibiotics or intravenous immunoglobulin.

Myeloma can be a chronic disease

Thanks to new therapies, myeloma may become a chronic disease in some patients. To achieve this, financing of new drugs is urgently needed in Poland, said experts during the XXVII Congress of the Polish Society of Hematologists and Transfusionists in Warsaw.

Dr. Dominik Dytfeld, president of the Polish Myeloma Consortium, admitted that the treatment of myeloma is complicated. It requires an individual approach to each patient and the use of multi-drug therapy. - It is an incurable neoplasm and it always recurs after applying the first line of treatment, becomes resistant to therapy, so we use the second line, and then the third one and the next - explained the hematologist.

Currently, in Poland, access to the first and second-line treatment of myeloma is at a good or medium level. - Unfortunately, in the third line, we can only use the old chemotherapy that is thereassociated with a number of complications (…), but also have a very limited effectiveness. We are not able to use new drugs - emphasized the hematologist.

According to specialists, the most urgent funding requires three new drugs that can significantly extend the life of patients with relapsed and refractory myeloma to older therapies: daratumumab, pomalidomide and carlizomib.

Thanks to medical advances, myeloma may be a chronic disease, not a sentence

Where to go for help

Polish Society for Aid to Myeloma Patients

ul. Kołobrzeska 50 p. 910-434 Olsztyn

Oncology helpline open from Monday to Thursday from 4 p.m. to 10 p.m., phone: + 48 800 493 494, phone / fax + 48 89 534 25 90, mobile phone: + 48 606 125 160, e-mail : [email protected], [email protected]

Myeloma Treatment Center Foundation

Public benefit organization, ul. Ignacego Łukasiewicza 1, 31-429 Kraków, tel. +48 601 539 077, fax +48 12 617 7580, www.szpiczak.org, e-mail: [email protected]

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Category:

Oncology