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Multiple myeloma is a type of blood cancer that originates from the abnormal proliferation of plasma cells (a type of white blood cell or immune cell). These plasma cells can damage the bones if they grow excessively and cause anemia. At the same time, they are capable of producing immunoglobulins, proteins that in excess can harm the kidneys and increase the risk of infections.
Its annual incidence in adults is 4–6 new cases per 100,000 inhabitants per year, representing 1% of all cancers and 10% of blood cancers, figures that place it among rare diseases. It usually affects predominantly older adults, with an average age of 70 years.
Excess immunoglobulins (Ig) interfere with the properties of the blood, the normal function of the kidneys, and promote the development of infections (since the production of other normal Igs is reduced). If there is also an excess of plasma cells, the bones containing the bone marrow can be damaged, leading to fractures and pain. Normal production of red blood cells, white blood cells, and platelets may also be impaired, increasing the risk of anemia, infection, and bleeding.
The classic symptoms of multiple myeloma are summarized by the English acronym for the affected organs: “CRAB” (Calcium, Renal, Anemia, Bone). However, other symptoms may also occur:
Anemia (most common symptom): fatigue, weakness, dizziness, sleepiness
Fever, infections
Bleeding
Peripheral neuropathy: tremors, cold hands and feet
Bone pain
Renal failure: edema/swelling, decreased urine output or anuria
Organ dysfunction due to protein deposits in different organs
Skin rashes
Constipation, diarrhea
Often, monoclonal gammopathy is found incidentally in a routine blood test, or anemia is detected, or a fracture is diagnosed after persistent bone pain that does not improve with conventional painkillers.
To confirm the diagnosis and determine the extent of the disease or the need for treatment, the following are required:
Complete blood tests with specific protein studies
Urine analysis to rule out abnormal protein excretion by the kidneys
Bone marrow aspiration or biopsy to confirm excess plasma cells (with cytometric and genetic studies if possible)
Imaging tests to rule out bone lesions
The treatment of multiple myeloma has changed significantly over the past decade, especially in recent years, with the emergence of new drugs and mechanisms of action.
The goal of treatment is to control the disease for as long as possible with minimal side effects and to achieve a good quality of life.
Treatment of multiple myeloma includes drugs that can be classified according to their mechanism of action:
Proteasome inhibitors
IMiDs (immunomodulatory drugs)
Alkylating agents
Corticosteroids
Monoclonal antibodies
In addition to these drugs, which can be combined, the treatment plan may also consider the possibility of one or two bone marrow transplants.
In multiple myeloma, the development of new treatments is growing exponentially. New drugs with different mechanisms of action or potentially beneficial combinations are being developed, which in selected cases may be offered within clinical trials.
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