In modern conditions of environmental degradation, a terrible word - oncology - is increasingly heard. Among all types of cancer, multiple myeloma occupies a special place. The etiology of this disease still raises more questions than answers. What is it - myeloma, why does it appear, who is at risk - this article is about this.
Many names, one essence
Myeloma (from the Greek myelos - brain) is a systemic lesion of the body associated with cells of the hematopoietic system - precursors of B-lymphocytes, which are capable of differentiating into plasma cells. According to the International Classification of Diseases, it has the code C.90 - C.93, refers to chronic leukocytic leukemia. In various sources, multiple myeloma is called myeloma, Rustitzky-Kahler disease, multiple myeloma, generalized plasmacytoma. But whatever it is called, it is a malignant formation of plasma cells, localized mainly in the bone marrow. Normally, the bone marrow produces a certain amountplasma cells. With the development of the disease, their number increases, and the formation of normal blood cells (leukocytes, erythrocytes) decreases. Instead of antibodies that are responsible for immune defense, defective proteins are produced.
Statistics and reasons
Of the neoplasms of plasma cells, myeloma is the most common and accounts for up to 10% of all malignant blood diseases. Most of the patients are men over the age of 45. The main peak of multiple myeloma falls on the category of patients aged 65 to 70 years. This pathology is not diagnosed in children.
The etiology of the disease remains unclear. Analysis of the patient history does not reveal toxic effects and antigenic stimulations.
Process microbiology
Plasma cells (plasmocytes) are the cells that provide our immunity. They produce antibodies - the main proteins of the body's fight against pathogens. They are formed from the precursors of B-lymphocytes, and this happens in the bone marrow, lymph nodes and intestines. In a he althy person, plasma cells make up 5% of the cells contained in the bone marrow. If their number becomes more than 10%, they talk about the development of multiple myeloma (photo below - plasma cells are painted in a darker color).
The process of formation of plasma cells consists of six stages, and only at the last stage of differentiation, lymphocytoplasmic cells acquire the ability to secrete antibodies (immunoglobulins) that canresist various pathogens (viruses and bacteria). Thus, a normal plasma cell is a single-celled gland of the immune system that secretes hundreds of antibodies per second.
How myeloma develops
One of the six stages of plasma cell formation may fail, and instead a myeloma cell with malignant properties, which consists in its continuous division, is formed. The accumulation of these cells, formed by dividing the original, is called plasmacytoma. It grows into bones or muscles, can be single or multiple. Myeloma cells themselves do not enter the bloodstream, but they secrete a lot of paraprotein - pathological immunoglobulin. It does not play any role in the processes of immune defense, but is deposited in the tissue. It is he who is found in diagnostic blood tests.
In addition to paraproteins, such plasma cells secrete special proteins - cytokines. These protein molecules stimulate the growth of malignant cells, depress the immune system, activate osteoclasts - bone destroyers, activate the growth of fibroblasts (they increase blood density and lead to bruising and bruising), disrupt protein metabolism, which leads to damage to the kidneys and liver. In bone tissue, myeloma plasma cells provoke the destruction of cartilage and bone tissue, voids form in it.
Classification
This disease is a cancer of plasma cells, which results in the body's inability to resist pathogens and problems in the circulatory system. According to the nature of the spread of the tumor inin the bone marrow, diffuse, diffuse-nodular and multiple-nodular forms of the disease are distinguished. According to the cellular composition, myelomas are plasmacytic, plasmablastic, polymorphic-cellular, small-celled. Depending on the type of paraproteins secreted by myeloma plasma cells, there are the following forms of the disease: non-secreting myelomas, dyclonal, Bence-Jones myeloma and G, A, M myelomas.
Risk groups
The causes of multiple myeloma are not known, but there are certain factors that increase the likelihood of the disease:
- Men over 40. It is believed that with a decrease in the level of sex hormones in men, the risk of myeloma increases. Women get sick very rarely.
- Genetic predisposition. 15% of patients had relatives who had this disease.
- Overweight. Metabolic disorders in obesity reduce the body's immune status and create conditions for the development of malignant cells.
- Radiation and toxins. People who have undergone radiation therapy, liquidators of the Chernobyl accident and those who are exposed to long-term exposure to asbestos, arsenic are more likely to mutate B-lymphocytes. Some studies provide data on a similar effect of nicotine and alcohol.
- Immune-compromised people who are HIV-infected and taking medications that suppress the immune response.
- People with black skin are twice as likely to get sick as people of Caucasian and Asian races.
Symptoms of multiple myeloma
Byethere are not very many myelin cells, the disease can be asymptomatic. As their number increases, they replace normal cells in the bone marrow, and more and more paraproteins enter the bloodstream. With multiple myeloma, symptoms are manifested primarily by bone tissue, kidneys and the immune system. In this case, the clinical picture depends on the stage of tumor development and the amount of paraproteins in the blood. In 10% of patients, abnormal cells do not produce defective proteins, and the disease proceeds without symptoms. The clinical picture of multiple myeloma of the blood is dominated by:
- General weakness and constant fatigue.
- Dramatic weight loss.
- Pain in bones and muscles. Headaches.
- Pathological bone fractures.
- Immune status disorders, frequent infectious diseases.
- Increased blood viscosity and high ESR over a long period.
- Trophic lesions of the lower extremities, not associated with varicose veins.
- Sclera hemorrhage, gum bleeding, subcutaneous hemorrhage and bruising.
- Kidney damage.
What happens to the bones
In most clinical cases, axillary resorption of bone tissue with the formation of cavities is observed. Sometimes there is a smooth or lacunar tissue resorption. With the destruction of bones in the kidneys, lungs and blood vessels, phosphorus-lime masses are deposited according to the type of metastasis. In areas of microfractures, focal neoplasms may form.bone substance - osteosclerosis.
Together with the bone marrow in the lymph nodes, tonsils, spleen and liver, focal or diffuse infiltrates are found. In severe cases, there is infiltration of these organs, their increase, nodular growths. Such manifestations of myeloma bring its manifestations closer to severe leukemia and complicate treatment, aggravating the prognosis of the course of the disease.
Clinical stages of the disease
It is believed that up to 15 years pass from the moment of the formation of the first tumors until the onset of symptoms of the disease. There are two stages in the course of myeloma:
- Benign stage. It is characterized by somatic compensation, a slow increase in bone pathology, moderately reduced blood counts, a preserved immunoglobulin titer, and a slow increase in the level of paraproteins. The prognosis of treatment in this period is often favorable.
- Terminal stage. This is a period of acute inhibition of normal hematopoiesis, the appearance of anemia, leukemia, thrombocytopenia. The level of normal antibodies drops sharply, up to their complete replacement with paraproteins. Metastasis with the formation of nodes in various organs with a feature of aggressive growth of tumors indicates the transition of the disease to malignant sarcoma. The prognosis of the course of the disease is not so favorable.
Which doctor to contact
Diagnosis of multiple myeloma is done by a hematologist. The definition is often difficult due to the general nature of the patient's complaints and the absence of symptoms in the initial stages. Clarification of the diagnosisbased on additional research:
- Clinical blood test. Multiple myeloma is characterized by an increase in viscosity and erythrocyte sedimentation rate (ESR), a decrease in the number of platelets and erythrocytes, and a low content of hemoglobin.
- Blood test for electrolytes. With multiple myeloma, tests show an increase in calcium levels. Blood biochemistry is characterized by an increased content of total protein, high numbers of urea and creatinine.
- Analysis of blood levels of paraproteins or abnormal antibodies.
- Urine tests show abnormal immunoglobulin chains (Bence-Jones proteins).
- X-ray of bones showing cavities consistent with myeloma. Computed tomography, MRI, PET scan will show the same damage.
- The most reliable way to diagnose multiple myeloma is a sternal puncture of the bone marrow. It is taken from the sternum or pelvic bones, examined under a microscope to determine myeloma plasma cells.
Treatment is difficult and lengthy
After diagnosing multiple myeloma, treatment is carried out in a hospital setting. Complex drug therapy is used, including:
- Targeted therapy with drugs that affect protein synthesis and lead to the death of plasma cells (for example, the drug "Carfilzomib").
- Biological therapy is aimed at stimulating the immune system (eg Thalidomide or Lenalidomide).
- Chemotherapyis aimed at inhibition of tumor growth and the death of pathological cells ("Cyclophosphan" and "Melphalan").
- Corticosteroid therapy is used as an adjunct.
- Bisphosphonates ("Pamidronate") are prescribed to increase tissue density.
- Analgesics are used when necessary to relieve pain.
Surgical intervention if necessary. For example, if it is necessary to fix the vertebrae, when bone destruction is detected.
Bone marrow transplantation is possible. In this case, stem cell transplantation of the patient's own bone marrow is more often used.
It is important to follow all doctor's orders and strictly adhere to the schedule of control checks. Then the prognosis of multiple myeloma may be favorable.
Associated Complications
As with any systemic disease, in this case, complications can be as follows:
- Very severe pain that requires high-quality anesthesia.
- Renal failure, up to the need for hemodialysis.
- Frequent and prolonged infectious diseases.
- Pathological fractures due to bone thinning.
- Anemia requiring a blood transfusion.
Myeloma and prognosis
Meloma care is much more optimistic today than it was 20 years ago. On average, out of 100 patients, 77 will live another year, and 23 will live at least 10 years. The so-called "smoldering" myeloma,which does not progress and is almost asymptomatic for many years, requires regular examinations by a doctor and monitoring the development of the disease. Early diagnosis of activation of bone destruction and proper therapy make the prognosis most favorable.
Death most often occurs as a result of infectious complications, critical blood loss, severe renal failure and pulmonary embolism.
Prevention and advice
Myeloma is unpredictable and insidious. Therefore, there is no special prevention. There are studies that show a correlation between a he althy and active lifestyle in old age and a reduced risk of disease. In the initial stages of the development of the disease, patients are advised to adhere to certain dietary rules, namely:
- Exclude canned and processed foods from the diet.
- Increase iron-rich foods - bell peppers, red meat, broccoli, papaya, mango.
- Include more fruits and vegetables in your diet.
- Reduce protein intake, including milk and dairy products, eggs, beans, nuts.
There are studies on the beneficial effects of the oriental spice turmeric. It contains the antioxidant curcumin, which has anti-inflammatory properties and helps slow down the growth of tumor cells, as well as prevents resistance to chemotherapy drugs.
What traditional medicine advises
Folk treatments for diseasedivided into two groups:
- Therapy based on the intake of infusions of poisonous plants (hemlock, fly agaric, celandine), which is aimed at slowing down the growth of tumors. These plants contain alkaloids similar to the effects of chemotherapy. The intake of such funds should be very careful - exceeding the dosage can lead to severe poisoning and even death. Dosage is best discussed with your doctor.
- Reception of infusions aimed at improving the immune status and general condition of the patient. Apply infusions based on marsh cinquefoil, medicinal sweet clover, medicinal veronica, meadowsweet, comfrey, milkweed. These funds will not be able to defeat the disease, but they can improve the quality of life and the general well-being of the patient.
It is desirable to use the means of the first and second groups in a complex manner. At the same time, funds based on poisonous plants are used in courses with a mandatory break. And any remedy should not be used for more than a month, in order to avoid addiction of the body and loss of the healing effect. In any case, before using folk remedies, you should consult with your doctor. Modern medicine is far from being as conservative as we used to think and is ready to consider all options for a favorable prognosis of multiple myeloma.
