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Specialists in the Field of Multiple myeloma
Information About the Field of Multiple myeloma
Multiple myeloma belongs to the group of non-Hodgkin's lymphomas. It is characterized by multiple tumor foci in the bone marrow and the dissolution of the bone substance in the surrounding tissue. It belongs to malignant lymphomas, and the average age of onset is about 70 years. If only a single, also called solitary, focus occurs in the bone marrow. The tumor is called plasma cell myeloma.
What Is Multiple Myeloma?
Multiple myeloma, also called Kahler's disease, is malignant cancer that originates in lymphoid tissue. It is also called a lymphoproliferative B-cell disease because of the increased proliferation and accumulation of degenerate plasma cells. These plasma cells belong to the acquired immune system and mature from the group of B lymphocytes, a subtype of lymphocytes belonging to the white blood cells.
The plasma cell takes on the task of producing antibodies for the immune system and, in this way, fending off pathogens. If degenerated plasma cells proliferate, useless antibodies are produced, so-called paraproteins. This reduces the number of functional antibodies, resulting in a disorder of the immune system with susceptibility to infection. In addition, the excessive number of degenerated cells displaces other important cells in the hematopoietic system. For this reason, anemia, a decrease in platelets, which serve for blood clotting, and weakness of the immune system may occur.
The causes of multiple myeloma are still largely unknown. However, risk factors include age and environmental factors such as radiation, pesticides, and excessive exposure to solvents. In addition, a familial clustering has been observed, suggesting a hereditary component of the disease.
Patients may remain asymptomatic for a prolonged period or present with nonspecific general symptoms. Typical symptoms of cancer include fatigue, night sweats, fatigue, and weight loss.
Bone pain and pathologic fractures may occur in multiple myeloma due to changes in bone structure and a decrease in bone density. Likewise, an increase in the protein content of the blood is seen so that damage to the tiny renal tubules can occur, resulting in renal insufficiency. In addition, the increase in protein leads to increased protein excretion in the urine, which can be noticeable to patients as foamy urine. An increase in calcium levels is noticed in the blood count of many patients. Other symptoms such as numbness in the extremities may also be evident.
Due to the prolonged absence of symptoms and the multitude of different symptoms, patients with multiple myeloma often receive their diagnosis relatively late. To establish the diagnosis, a detailed physical examination and a symptom-oriented patient interview take place initially. Subsequently, a blood count may reveal abnormal laboratory parameters. Elevated protein levels, immunoglobulins, and altered inflammation levels may be noticed here. In addition, an examination of the urine can reveal increased protein excretion.
Imaging techniques such as computed tomography or magnetic resonance imaging reveal bone foci and a reduction in bone density and tumor foci in surrounding tissues. To assess the foci more precisely, it may be necessary to perform a bone marrow puncture, usually taken from the iliac crest. The stage of the disease is then classified based on collected criteria and laboratory parameters and renal function impairment. Finally, the disease stage and general condition determine the need for treatment.
Is Multiple Myeloma Leukemia?
Multiple myeloma, like acute and chronic leukemias , originates from white blood cells. Nevertheless, by definition, it is not considered a leukemic disease since these are associated with a disturbed maturation process of the precursor cells of the white blood cells. Multiple myeloma is also called bone marrow cancer. It belongs to the non-Hodgkin's lymphomas due to the maturation disorder of the monoclonal precursor cells of the plasma cells, which originate from the B lymphocytes.
How Is Multiple Myeloma Treated?
There are different treatment options for multiple myeloma, which are applied depending on the patient's general condition and based on the stage of the disease.
The pillars of therapy for the disease include chemotherapy , which can be given with or without stem cell transplantation. Patients with the severely impaired general condition or advanced age are usually treated with standard chemotherapy, as high-dose chemotherapy would entail too high risks.
High-dose chemotherapy with stem cell transplantation , on the other hand, is the standard therapy for multiple myeloma and is given to patients younger than 70 with good general health. Here, induction therapy is first performed to initiate treatment, followed by stem cell collection. High-dose chemotherapy can then be undergone, followed by stem cell transplantation. Often this procedure is repeated a few months later, as this often leads to better results.
In addition, thanks to intensive research, there are novel substances for the treatment of myeloma that lead to improved survival and quality of life for the patients. These include antibody therapies , novel immunomodulators, cytostatics, and steroids. A combination of several substances often achieves the best results.
Radiation therapy can also be used since multiple myelomas are very radiation-sensitive and therefore respond well to radiation. In this way, for example, bone pain caused by bone foci can be alleviated.
Concomitant therapies to alleviate therapy-associated symptoms should also be part of the therapy regime. Fluid infusions and the administration of bisphosphonates are given, for example, to prevent further bone damage, as is the treatment of possible anemia and the tendency to infections.
Cure and Prognosis
In most cases, multiple myeloma is non-curable cancer that leads to the long-term death of patients. Nevertheless, thanks to the most modern therapeutic approaches, the survival time and the quality of life of patients have been significantly improved.
However, the prognosis of each individual patient depends on various criteria that usually cannot be generalized. These criteria include, for example, the severity of the renal dysfunction, different laboratory parameters at the onset of the disease, and, of course, the patient's general condition, which determines the therapeutic options. In addition, solitary plasmacytoma shows better chances of cure, whereas a permanent cure of multiple myeloma is extremely rare.
Which Doctors and Clinics Are Specialized?
Treatment is generally carried out in a clinic for hematology and oncology by specialists in blood diseases and diseases of the lymphatic system. However, the therapy of oncological diseases is always interdisciplinary in cooperation with various specialties, including internists, radiation therapists, and psychologists.
- Kurzlehrbuch Innere Medizin. Baenkler H, Bals R, Goldschmidt H, Hahn J, Hinterseer M, Knez A, Möhlig M, Pfeiffer A, Schäfer J et al., Hrsg. 4., vollständig überarbeitete Auflage. Stuttgart: Thieme; 2021. doi:10.1055/b000000422
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