Myeloma: symptoms and treatment
Myeloma (multiple myeloma) is a disease that occurs in the blood system and belongs to the paraproteinemic leukemia group. Myeloma, the symptoms of which are manifested due to the appearance of a tumor in B-lymphocytes, are observed most often among the elderly in the most frequent cases, and only in rare cases can it occur before the age of forty.
The causes that contribute to the development of myeloma, to this day and remain unknown. Among the potential risks contributing to its occurrence, contact with pesticides and radioactive substances, with benzene, as well as with certain types of organic solutions, is distinguished.
In general, the manifestations of myeloma are characterized by the multiplicity of the appearance of its inherent tumor lytic formations, centered in the bones, osteoporosis, as well as diffuse plasmacytosis, localized in the bone marrow. Circulation of myeloma proteins produced by plasmatic cells in a significant amount occurs in plasma, which makes it possible to increase its volume, as well as the general viscosity inherent in later blood. There is an interaction of myeloma proteins and factors contributing to blood clotting, due to which they are enveloped by platelets. This has a corresponding effect on the function of the latter, thereby increasing their bleeding.
Plasmotic cells, in addition to myeloma proteins, also have the ability to produce various types of cytotoxic factors, for example, those factors that can activate the function of osteoclasts. Already at the expense of osteoclasts, resorption of bone tissue is caused, which is manifested for the patient in pain in bones and pathological fractures. In addition, hypercalcemia is also formed.
Because of the infiltration in the bone marrow, anemia occurs, and it can manifest itself in a variety of degrees of severity. The main symptoms of anemia are: marked weakness, increased fatigue, low blood pressure, trembling of the hands, dizziness, reaching in some cases a presyncope, and, as a result, fainting. Also the consequence of infiltration is leukopenia or / thrombocytopenia. As a result of a decrease in the total number of leukocytes, as well as violations in the synthesis of immunoglobulins, it becomes possible to manifest in the form of depression humoral immunity, as well as immunity of the cellular (to a lesser extent). This circumstance determines the increased sensitivity of patients in relation to a number of infections (mainly bacterial).
Classification of myeloma
Myeloma disease can occur in several variants of the development of the process, which are determined in part by the nature of the spread inherent in myeloma infiltrates in the bone marrow, as well as the nature of the myeloma cells themselves and the type of paraprotein synthesized.
- Depending on the nature of the prevalence of the tumor in the bone marrow environment, the following forms of myeloma are determined:
- diffuse myeloma;
- diffuse focal myeloma
- focal myeloma.
- Depending on the characteristics of the cellular composition, determine the myeloma:
- Depending on the secretion of certain types of paraproteins, the following types of disease are determined:
- Non-secretory myeloma;
- diplonous myeloma;
- Bence-Jones myeloma;
- M-, A-, G-myeloma.
The most common variants are Bence-Jones myeloma (15% of the total number of observations), and A- (20%) and G-myeloma (70%).
Symptoms of myeloma
For a long time myeloma can be characterized by its own asymptomatic course, manifesting itself only in an increase in the indicator in the analysis of the blood of the ESR. Subsequently, her development is a frequent state of weakness, there is a slimming patient, in addition, he also has pain in the bones. Manifestations of an external character often arise from the defeat of bones, as well as immunity, anemia, increased blood viscosity, changes in kidney function.
It is noteworthy that bone pain is the most common sign that indicates the presence of myeloma. The localization of pain is mainly concentrated in the area of the ribs and spine, and they are felt mainly during the movement. Localized in certain areas of pain of an uninterrupted type, as a rule, indicate the presence of fractures.
In myeloma, bone destruction is caused by the actual process of growth that occurs in the tumor clone. Due to the destruction of bones, calcium is mobilized from the bones, which in turn leads to the appearance of characteristic complications in the form of nausea and vomiting, as well as to drowsiness and, in some cases, coma.
As a result of subsidence of the vertebrae, signs appear that indicate the compression of the spinal cord. Due to this, carrying out the roentgenogram allows to determine whether the presence of foci of destruction in the bone tissue, or the general form of osteoporosis.
A frequent symptom of myeloma is becoming susceptible to infections of patients, which occurs as a result of a decrease in the characteristics of the immune system. It is noteworthy that more than half of the patients face with kidney damage.
Because of the increased viscosity of the blood in patients with myeloma, neurological symptoms are noted, which manifests itself in the form of headaches, visual disturbances, fatigue, and damage to the eye retina. Some patients are faced with the «goose bumps» in the feet and hands, as well as their tingling and numbness.
For the initial stage of the disease, the absence of any changes in blood can be inherent. Meanwhile, about 70% of patients experience the development of increasing anemia, which occurs due to the process of replacement by bone marrow tumor cells, as well as oppression of the hematopoietic function by actual tumor factors. In some cases, anemia acts as the initial and, at the same time, the main manifestation of the disease we are considering.
As we have already noted, there may be an increase in ESR, which is in itself a classic manifestation of myeloma. In some cases, the ESR is about 90mm / h. Varying is observed in the number of leukocytes, as well as in the leukocyte formula. The detailed picture of myeloma determines the possibility of reducing the level of indicators of the total number of leukocytes, in addition, in many cases, myeloma cells are detected.
Diagnosis of myeloma
The cytological picture characteristic of the marrow punctate possesses about 10% of myeloma cells, which differ in their structural features and atypical cells of the plasmoblast type, which are also very specific for the disease in question
Classical components in the symptomatology of myeloma are represented in the form of bone marrow plasmacytosis (> 10%), urinary or serum M-component, and also as osteolytic lesions. The reliability of the diagnosis is determined on the basis of the presence of the first two components.
An additional role in the diagnosis is played by changes in bones, determined by the X-ray method. An exception may be extramedullary myeloma, the process of which often occurs in combination with the involvement of lymphoid nasopharyngeal tissue, as well as paranasal sinuses.
Following the establishment of a diagnosis of myeloma as a rule, the appointment of appropriate treatment is recommended. The tactic of waiting is justified solely with the slow-moving form of the disease, in which there is a lack of characteristic manifestations. In this situation, patients are assigned a dynamic observation, treatment is prescribed for the progression of the disease.
The main criterion indicating the need for a specific type of therapy for myeloma disease is the presence of lesions in target organs.
The main method of treatment is chemotherapy with the use of cytotoxic drugs. In addition, the actual introduction of symptomatic treatment, focused on adequate correction of hypercalcemia. It also uses analgesics, hemostatic and orthopedic therapy.
The solitary form of myeloma requires the need for surgical treatment, its actual use is also relevant in the case of the presence of relevant signs indicating the squeezing of vital organs. As a palliative treatment, radiotherapy is used for patients in a weakened state, as well as for the onset of renal insufficiency and for tumor resistance in relation to the chemotherapy used. Often, radiation therapy is also applicable in the case of the formation of local bone lesions.
Due to the peculiarities of modern treatment, the life of patients with myeloma can be extended on average by 4 years. Sensitivity to the treatment used with the use of cytotoxic drugs largely determines the duration of life, in patients with a primary resistance to their treatment, the average survival rate varies within a year.
Long-term treatment with cytostatic agents leads to an increase in the occurrence of acute forms of leukemia (up to 5%), in rare cases, the development of acute leukemia is observed in patients without using this type of treatment.
The life expectancy is also determined by the stage during which the diagnosis was established. As the causes of death, the progression of myeloma, sepsis, renal failure is determined. Some patients die due to stroke, myocardial infarction, and a number of other causes.
In the case of the appearance of a symptomatic symptomatic myeloma, consultation of such specialists as a hematologist and oncologist is necessary.