Myeloma has many synonymous names. In speeches of specialists, it can be designated as generalized plasmacytoma, reticuloplasmocytosis, Rustitzky-Kahler's disease or myelomatosis. The most commonly used of these are the terms myeloma and myeloma.
What is myeloma?
As a form of hemoblastosis, myeloma is a malignant tumor characterized by the accelerated growth of plasmocytes - cells that produce paraprotein( a pathological protein).
The mutation that affects these cells leads to the fact that their number in the tissues of the bone marrow and in the blood is steadily growing. Accordingly, the amount of paraprotein synthesized by them grows.
The picture shows a bone marrow smear with multiple myeloma and without
The main criterion of myeloma malignancy is the number of transformed plasmocytes many times higher than normal.
- Myeloma develops when the processes of proper development and transformation of B-lymphocytes into cells of the immune system-plasmocytes-are disturbed. At the same time, the synthesis of immunoglobulins produced by them( antibodies that help to destroy pathogenic viruses and bacteria) is inevitably disrupted.
- Myeloma is a malignant tumor formed by constantly multiplying monoclonal plasmocytes, which not only do not perish but divide and synthesize the paraproteins uncontrollably. Penetrating( infiltrating) into tissues and internal organs, paraproteins interfere with their normal functioning.
- Myeloma develops mainly in mature( over forty) and elderly patients. For young people, this disease is not typical. The older the patient, the higher his risk of developing myeloma, and it infects men more often than women.
- Myeloma growth is extremely slow. The moment of formation of the first plasmocytes in bone marrow tissues and the beginning of the formation of tumor foci can divide two or even three decades. But after the clinical manifestations of myeloma are known, it begins to progress dramatically. Already two years after this, the vast majority of patients die from numerous complications that developed in those organs and systems that were affected by paraproteins.
The basis for the classification of myeloma is the clinical and anatomical features of the presence of plasmocytes in bone marrow tissues, as well as the specificity of their cellular composition. On how many organs or bones are affected by the tumor, the division of myelomas into solitary and multiple depends.
- The solitary mydomas of are distinguished by the presence of only one tumor site located either in the lymph node or in bone that has bone marrow.
- Multiple myeloma always affects several bones containing the bone marrow. Myeloma often affects bone marrow tissue of vertebrae, scapula, wings of the ilium, ribs, bones of the skull. Malignant tumors are often formed in the central part of the tubular bones of the upper and lower extremities. Equally vulnerable are the spleen and lymph nodes.
Depending on the location of the plasmocytes in the bone marrow of myeloma there are:
- is multiple-focal.
Cellular composition of myelomas allows them to be divided into:
- polymorphic cell;Small cell
As in most oncological diseases, the true causes of myeloma are still not established. The nature and extent of the impact of pathogenic factors on the transformation of damaged cells has also been little studied.
Physicians suggest that the main causes of myeloma disease can be considered:
- Genetically determined predisposition. This ailment often affects very close relatives( they often suffer from identical twins).All attempts to identify oncogenes, provoking the development of the disease, have not yet been successful.
- Prolonged action of chemical mutagens ( as a result of inhalation of mercury vapors and domestic insecticides, asbestos and benzene-based substances).
- The impact of all types of ionizing radiation ( protons and neutrons, ultraviolet, X-rays and gamma rays).Among the population of Japan, survived the tragedy of Hiroshima and Nagasaki, myeloma is extremely frequent.
- Presence of chronic inflammations, which require a prolonged immune response from the patient's body.
The extent of the lesion and the severity of the flow allow us to distinguish three stages of myeloma. At the first stage, the tumor process fits into the following parameters:
- The blood contains a sufficient amount of calcium.
- The level of hemoglobin concentration exceeds 100 g / l.
- There are still a few paraproteins in the blood.
- The Bens-Jones protein in the urine is present in a very small concentration( no more than 4 g per day).
- The total mass of myeloma does not exceed 600 g per square meter.
- There are no signs of osteoporosis in the bones.
- The tumor is located in only one bone.
The third stage of myeloma is characterized by the following parameters:
- The hemoglobin content in the blood is less than 85 g / l.
- The calcium content in 100 ml of blood exceeds 12 mg.
- Tumors have captured three bones( or more) at once.
- The content of paraproteins is very high in the blood.
- Very high( over 112 g per day) is the concentration of the Bence-Jones protein.
- The total mass of cancer tissues is more than 1.2 kg.
- A radiograph shows the presence of osteoporosis in the affected bones.
The second degree of myeloma, whose indices are higher than at the first, but do not reach the third, the doctor establishes by an exception method.
Organ damage and symptomatology
Myeloma primarily affects the immune system, the tissues of the kidneys and bones.
With the increase in the number of cancer cells, myeloma manifests itself as follows:
- Aching in the bones. Cancer cells lead to the formation of voids in bone tissues.
- Pain in the heart muscle, tendons and joints of , caused by the deposition of paraproteins in them.
- Pathological fractures of vertebrae, femurs and ribs. Because of the large number of cavities, the bones become so fragile that they do not withstand even small loads.
- By reducing the immunity of .Affected by the disease, the bone marrow produces such a small amount of leukocytes that the patient's body is not able to protect itself from the effects of pathogenic microflora. As a result, the patient suffers from endless bacterial infections - otitis, bronchitis and angina.
- Hypercalcemia. The destruction of bone tissue leads to the ingress of calcium into the blood. In this case, the patient develops constipation, nausea, abdominal pain, weakness, emotional disorders and inhibition.
- Myeloma nephropathy - a violation of the proper functioning of the kidneys. Excess calcium causes the formation of stones in the renal ducts.
- Anemia. A damaged bone marrow produces less and less red blood cells. As a result, the amount of hemoglobin responsible for oxygen delivery to cells also decreases. Oxygen starvation of cells is manifested in severe weakness, decreased attention. At the slightest burden, the patient begins to suffer from palpitations, headaches and shortness of breath.
- In blood clotting disorder. In some patients, the viscosity of the plasma increases, due to which spontaneously sticking red blood cells can form thrombi. Other patients, in whose blood the number of thrombocytes has sharply decreased, suffer from frequent nasal and gingival hemorrhages. When the capillaries are damaged, subcutaneous hemorrhage occurs in these patients, which are manifested in the formation of a large number of bruises and bruises.
Diagnosis of myeloma begins with a preliminary medical examination. Collecting the anamnesis, the expert in detail asks the patient about existing complaints and features of the clinical picture, without forgetting to specify the time of their appearance.
Thereafter, the obligatory palpation of the painful areas of the body follows with a series of clarifying questions about whether pain intensification occurs and if its return is present in other parts of the body.
Having collected the anamnesis and having come to the conclusion about the possibility of myeloma, the specialist assigns to the patient a number of such diagnostic studies:
- X-ray of chest and skeleton.
The photo shows a hand bone X-ray showing myeloma
- Magnetic resonance and computed tomography( spiral).
- Aspiration of bone marrow tissue, necessary for creating a myelogram.
- Laboratory analysis of urine( according to Zimnitsky and general).Analysis of Zimnitskiy allows one to trace the daily dynamics of protein loss in urine. The analysis of urine for bons-jons protein is performed in order to verify the correctness of the diagnosis, since the urine of a healthy person does not contain it.
- Ben-Jones proteins can also be detected during the immunoelectrophoresis procedure.
- To assess the general condition of the hematopoietic system, a general analysis of 1 ml of blood taken from the vein or from the finger is performed. The presence of myeloma will be evidenced by: increased ESR, a significant decrease in hemoglobin, erythrocytes, reticulocytes, platelets, leukocytes and neutrophils, but the level of monocytes will be increased. The increase in the total amount of proteins is achieved due to the content of paraproteins.
- To assess the functioning of individual systems and organs, conduct a biochemical analysis of blood taken from the vein. The diagnosis of myeloma is confirmed by a complex of indicators in the blood, among them: an increased level of total protein, urea, creatinine, uric acid, calcium with a decrease in albumin content.
- The leading method of treatment of myeloma is chemotherapy, which is reduced to taking high doses of cytotoxic drugs.
- After effective chemotherapy, patients undergo transplantation of donor or own stem cells.
- When the effectiveness of chemotherapy is low, radiotherapy methods are used. The impact of radioactive rays does not heal the patient, but for a while it makes it possible to significantly alleviate his condition, in addition, increasing his life span.
- From painful pain in the bones get rid of with pain medications.
- Infectious diseases are treated with high doses of antibiotics.
- Hemostatics( like vicasol and etamzilate) will help cope with bleeding.
- From tumors squeezing internal organs, get rid of by surgical means.
Stem cell transplant
If the chemotherapy is successful, the patient is transplanted with his own stem cells. For bone marrow sampling, perform a puncture. Separating stem cells from it, they again plant them in the patient's body. With this manipulation it is possible to achieve a stable remission, during which the patient feels healthy.
- The diet for myeloma should be low-protein. The daily amount of protein consumed should not exceed 60 g.
- In an extremely small amount, one should consume beans, lentils, peas, meat, fish, nuts, eggs.
- All other products that are well perceived by the patient can be safely included in the diet.
Modern methods of treatment can extend the life of a patient suffering from myeloma, for almost five years( in very rare cases - up to ten).In the absence of therapeutic assistance, he can live no more than two years.
If treatment with cytostatic drugs is carried out for a long time, the patient may develop acute leukemia( the frequency of such cases is up to 5%).The incidence of acute leukemia in patients who did not receive such treatment is extremely rare.
Another factor affecting the life expectancy of patients is the stage of diagnosing the disease. The causes of death can be:
- itself a progressive tumor( myeloma);
- blood poisoning( sepsis);
- myocardial infarction;
- kidney failure.
On the symptoms of myelomatosis will tell this video: