Multiple myeloma

Multiple myeloma is a malignant neoplasm of plasma cells involving bone and bone marrow, frequently leading to extensive skeletal destruction, bone marrow failure, renal dysfunction, and problems related to the monoclonal myeloma proteins. Vigilant supportive care and effective chemotherapy can prolong survival and improve the quality of life in most patients.     

Multiple myeloma

Mini-transplantations in leukemia or MDS in the elder patients are reported to have almost the same results as of the young patients. On the other hand, multiple myeloma is considered that no conventional chemotherapy is curable. Here are some reports of short term of observations at our hospital. We tried pre-conditioning with ATG(2.5/kg x 2), TBI(1 Gy x 2), L-PAM (70 mg x 2), M-Pred(700 mg/m2 x 5) to ten progressive multiple myeloma cases, 40% became mixed chimera and they all became completely donor type with DLI. In almost 4 years of observations, over all survival rate is 68% that it is worth while to continue this treatment.     

Multiple myeloma: an overview

Multiple myeloma (MM) is a malignant hematologic disorder involving plasma cells. In MM, immunoglobulin is overproduced, and patients can develop skeletal, hematologic, renal, and/or neurologic complications. The exact etiology of MM is unknown. The treatment for MM includes chemotherapy, antiangiogenic medications, and, most recently, a proteasome inhibitor. Nursing care for patients with MM requires close monitoring for infections and anemia, pain control, and education about the disease and treatment options. Further understanding of the pathophysiology of MM may lead to newer treatment options for the disease.     

Multiple myeloma: current perspectives

Multiple myeloma (MM) is a malignancy of terminally differentiated plasma cells characterized by complex genetic aberrations and heterogeneous outcomes. Over the past 25 years, cytogenetic analysis has played a key role in the diagnosis and management of MM. This article reviews the conventional cytogenetics, molecular cytogenetics, and genomic diagnostics of MM and highlights a few recent clinical trials that demonstrate the impact of genetic risk stratification on the treatment of this plasma cell malignancy.     

Multiple myeloma: diagnosis and treatment

Multiple myeloma, the most common bone malignancy, is occurring with increasing frequency in older persons. Typical symptoms are bone pain, malaise, anemia, renal insufficiency, and hypercalcemia. Incidental discovery on comprehensive laboratory panels is common. The disease is diagnosed with serum or urine protein electrophoresis or immunofixation and bone marrow aspirate analysis. Skeletal radiographs are important in staging multiple myeloma and revealing lytic lesions, vertebral compression fractures, and osteoporosis. Magnetic resonance imaging and positron emission tomography or computed tomography are emerging as useful tools in the evaluation of patients with myeloma; magnetic resonance imaging is preferred for evaluating acute spinal compression. Nuclear bone scans and dual energy x-ray absorptiometry have no role in the diagnosis and staging of myeloma. The differential diagnosis of monoclonal gammopathies includes monoclonal gammopathy of uncertain significance, smoldering (asymptomatic) and symptomatic multiple myeloma, amyloidosis, B-cell non-Hodgkin lymphoma, Waldenstr?m macroglobulinemia, and rare plasma cell leukemia and heavy chain diseases. Patients with monoclonal gammopathy of uncertain significance or smoldering multiple myeloma should be followed closely, but not treated. Symptomatic multiple myeloma is treated with chemotherapy followed by autologous stem cell transplantation, if possible. Melphalan, prednisolone, dexamethasone, vincristine, doxorubicin, bortezomib, and thalidomide and its analogue lenalidomide have been used successfully. It is important that family physicians recognize and appropriately treat multiple myeloma complications. Bone pain is treated with opiates, bisphosphonates, radiotherapy, vertebroplasty, or kyphoplasty; nephrotoxic nonsteroidal anti-inflammatory drugs should be avoided. Hypercalcemia is treated with isotonic saline infusions, steroids, furosemide, or bisphosphonates. Because of susceptibility to infections, patients require broad-spectrum antibiotics for febrile illness and immunization against influenza, pneumococcus, and Haemophilus influenzae B. Five-year survival rates approach 33 percent, and the median survival rate is 33 months.     

Multiple myeloma: the patient's perspective

Multiple myeloma is an incurable malignancy that accounts for 1% of all new cancers, usually affecting older patients. It follows a variable and unpredictable course. Despite years of research, outcomes remain poor. The purpose of this qualitative study was to gain an understanding of the impact of multiple myeloma on the patient and family. Based on 20 indepth telephone interviews, several themes were identified and analyzed. The results were surprising in that every patient interviewed considered the suddenness of having to face his mortality the most difficult obstacle to overcome. While specialized physical care will always be very important, the time has come for nurses to listen more carefully to the psychosocial concerns of this group.     

Multiple myeloma: recognition and management

Multiple myeloma is the malignant proliferation of plasma cells involving more than 10 percent of the bone marrow. The multiple myeloma cell produces monoclonal immunoglobulins that may be identified on serum or urine protein electrophoresis. Bone pain related to multiple lytic lesions is the most common clinical presentation. However, up to 30 percent of patients are diagnosed incidentally while being evaluated for unrelated problems, and one third of patients are diagnosed after a pathologic fracture, commonly of the axial skeleton. Multiple myeloma must be differentiated from other causes of monoclonal gammopathy, including monoclonal gammopathy of undetermined significance, heavy chain disease, plasmacytoma and Waldenstrom macroglobulinemia. Chemotherapy with melphalan-prednisone is the standard treatment for multiple myeloma. Other treatment modalities include polychemotherapy and bone marrow transplantation. Only 50 to 60 percent of patients respond to therapy. The aggregate median survival for all stages of multiple myeloma is three years.     

Multiple myeloma: innovations in diagnosis

Multiple myeloma (MM) belongs to the group of paraproteinemic hemoblastosis. Its clinical picture varies but the main clinical presentation is bone tumor proliferation resultant from enhanced resorption of tumor tissue related to bone marrow infiltration with plasmic cells, activation of osteoclasts. This leads to marked ossalgic syndrome and pathological bone fragility. MM often runs with nephropathy, immunodepression, hemopoietic disorders. Non-specific clinical manifestations of MM cause difficulties in making accurate diagnosis. Our clinic introduces innovative high-tech methods of examination including MR tomography of the body which detects the disease at early stages and, finally, allows us to prolong the patient's life.     

Multiple myeloma: diagnosis and treatment

Major advances have occurred in our understanding of the biology of multiple myeloma (MM) and in its treatment in the past decade. New diagnostic criteria have been developed, and an international Staging System has replaced the Durle-Salmon Staging System. It is now possible to classify MM as standard risk or high risk on the basis of specific Independent prognostic factors. The role of single and double autologous stem cell transplantation has been clarified by randomized trials. Most importantly, thalidomide, bortezomib, and lenalidomide have emerged as new active agents and are being incorporated rapidly into the treatment of both newly diagnosed and relapsed MM. The current approach to the diagnosis, prognosis, and management of MM is reviewed.     

加强对多发性骨髓瘤的研究

多发性骨髓瘤 (ＭＭ)是以骨髓中克隆性浆细胞恶性增殖和异常积聚为特征的肿瘤。美国肿瘤学会的最新统计资料表明 :在血液系统肿瘤中 ,其患病率已超过急性髓系白血病 ,仅次于非霍奇金淋巴瘤。在非洲裔美国人中 ,它是导致死亡的十大肿瘤之一。尽管目前在我国尚无有关ＭＭ的流行病学资料 ,但随着人口的老龄化 ,ＭＭ的发病也有逐年递增的趋势。因此 ,我国血液学工作者应高度重视对ＭＭ的研究。　　自 10年前发现白细胞介素 6(ＩＬ 6)在体内和体外均是骨髓瘤细胞的关键性生长因子以来 ,以ＩＬ 6为中心的细胞因子网络失调与ＭＭ临床特征的关系引起…