What is Multiple Myeloma :
The white blood cells are the cells involved in the body’s defense. Within find different types of leukocytes such as polymorphonuclear leukocytes, lymphocytes or monocytes, each with a specific function within the immune system.
The lymphocytes can be of different kinds. A subset of these leukocytes are B cells, which are responsible for antibody-mediated immunity and are generated and mature in the bone marrow.When other activated lymphocytes against the antigen specific B cells become plasma cells or plasma cells, which are responsible to secrete massive amounts of antibodies to this antigen.
When lost for various reasons control mechanisms of cell proliferation and programmed cell death occurs plasma hematological malignancy of these cells is called multiple myeloma.
How does it occur ?
Multiple myeloma accounts for 10% of hematological malignancies and its cause is unknown. There are no factors or conditions that predispose to cancer. It is more common in men of middle or advanced age.
Multiple Myeloma is a cancer formed by plasma cells, cells capable of secreting antibodies or immunoglobulins, so that a particular type of these immunoglobulins is elevated in blood, producing cells involved in multiple myeloma. This tumor is part of the so-called monoclonal gammopathy, tumors formed by cells with the capacity to produce immunoglobulins, which are coupled with multiple myeloma Waldenstrom’s macroglobulinemia, primary amyloidosis and gammopathy of undetermined significance.
Multiple Myeloma Symptoms
Up nearly 30% of patients with multiple myeloma have no symptoms and are diagnosed incidentally by finding Laboratory changes, including mild anemia, an elevated erythrocyte sedimentation rate (ESR) or a monoclonal paraprotein in blood , ie a type of antibody produced by plasma cells sick.
If symptoms, bone pain is the most common. Degeneration is due to the bone suffering production by tumor cells of substances that activate osteoclasts, the cells that resorb bone tissue. These lesions occur mainly in the skull, ribs, vertebrae, pelvis, and the ends of long bones such as the humerus or tibia. Occasionally, rather than osteolytic lesions, bone resorption, there is a diffuse osteoporosis. Bone lesions may involve, in addition to involvement of the periosteum pain, fractures at different points.
Hypercalcemia involved bone destruction can lead to fatigue, anorexia, nausea, vomiting, polyuria, polydipsia, constipation and confusion.
The bone marrow involvement which is occupied by plasma cells, and progressive anemia entails a decrease of the other cell lines.
Because of the defect in antibody-mediated immunity, the patient with multiple myeloma may suffer severe infections, especially in the lung and kidney. Infections are the leading cause of death in patients with multiple myeloma.
The kidneys are affected in about half of patients with multiple myeloma because of excess calcium in the blood, as well as by an excessive secretion of immunoglobulin (so-called light chains), which are excreted in the urine and give rise to a local feature called myeloma kidney. In the long term can cause kidney failure that can determine the patient’s poor prognosis, since this is the second cause of death in patients with myeloma after infection.
Excess immunoglobulins in blood makes the blood more viscous, which can produce episodes of interrupted blood flow in different areas, especially at neurological and ophthalmologic and cardiac or circulatory failure.
Sometimes plasma cells diseased tumor masses are grouped together in lymphatic tissues outside the bone marrow, lymphoid tissue mainly in otorhinolaryngology, which are called plasmacytomas.
It is noteworthy that may appear multiple myeloma associated with other abnormalities in what is called POEMS syndrome, which comprises polyneuropathies, enlarged organs, endocrine disorders, skin disorders and multiple myeloma. They are usually patients with a better prognosis.
Multiple Myeloma Diagnosis
The diagnosis of multiple myeloma can be casual in asymptomatic patients and be an analytical finding. Otherwise, this entity should be suspected in any patient with severe bone pain with no history of trauma, recurrent infections or renal involvement.
The blood tests will be appreciated anemia with erythrocyte size and amount of normal hemoglobin, an elevated ESR, a decrease in the number of leukocytes and platelets and altered the parameters measured coagulation. Also appreciate elevation of calcium levels in blood uric acid.
Both blood and urine will be appreciated a paraprotein elevation, ie a type of immunoglobulin that will be elevated. Among the different types of immunoglobulin G type is more frequent in multiple myeloma. The elevation of a particular protein, the beta-2-microglobulin, directly reflects the multiple myeloma tumor mass, but we can say that this protein is not specific for this disease.
In bone marrow was observed elevation of plasma cells, over 10% of the total plasma cells if over 30% of total data is considered that this confirms the diagnosis of multiple myeloma.
The fundamental imaging test to assess bone lesions is radiography.
In short, the diagnosis is based on the presence of one major factors (plasmacytomas the existence of more than 30% plasma cells in bone marrow and monoclonal immunoglobulin peak greater than 3.5 g / dl) and some minor factors (10-30% of bone marrow plasma cells, a monoclonal immunoglobulin peak below 3.5 g / dl, bone lesions and decreased normal immunoglobulins).
Multiple Myeloma Treatment
Patients who are asymptomatic and are diagnosed multiple myeloma initially require no treatment, since it has been seen that it prolongs survival.
Treatment of multiple myeloma in symptomatic patients have several options, such as chemotherapy, radiation therapy, interferons, immunotherapy, lenalidomide with dexamethasone or marrow transplantation. Bisphosphonate therapy aims to reduce bone involvement in patients with multiple myeloma.
Precautions
Given the unknown origin of multiple myeloma and the absence of risk factors there are preventive measures against him.