What happens in the body
Plasma cells are mature lymphocytes that normally produce antibodies against infections. In myeloma, one such cell acquires mutations and begins to endlessly copy itself. The clone fills the bone marrow, suppressing the formation of red blood cells, white blood cells and platelets, and releases substances that activate the destruction of bone tissue. This is how foci of osteolysis arise, calcium is released into the blood, and paraprotein light chains damage the renal tubules. Myeloma is often preceded by an asymptomatic condition - monoclonal gammopathy, which requires observation.
- Proliferation of a plasma cell clone
- Paraprotein production
- Destruction of bone tissue and areas of osteolysis
- Suppression of normal hematopoiesis
- Kidney damage from light chains
- Decreased protection against infections
Symptoms
The disease develops slowly, and the first complaints can easily be mistaken for age-related changes. The most common symptom is pain in the lower back, thoracic spine or ribs, which gets worse with movement and does not go away with conventional treatment. At the same time, anemia increases: weakness, pallor, and shortness of breath on exertion appear. Increased calcium causes thirst, nausea, constipation and confusion, and kidney damage causes swelling and decreased urine output. Frequent infections and unexplained weight loss are also alarming.
- Persistent pain in bones and back
- Fractures with minimal load, decreased height
- Weakness, pallor, shortness of breath
- Thirst, nausea, constipation, confusion
- Swelling and decreased urine output
- Recurrent infections
- Losing weight for no reason
Diagnostics
A combination of anemia, high calcium, elevated creatinine and a sharply accelerated ESR in an elderly patient with bone pain allows one to suspect myeloma. The diagnosis is confirmed by protein studies: electrophoresis and immunofixation of serum and urine reveal paraprotein, and analysis of free light chains clarifies its type. A bone marrow biopsy with calculation of the proportion of plasma cells and genetic testing is required. The skeletal condition is assessed using low-dose CT, MRI or PET - conventional radiography is less sensitive.
- Complete blood count and ESR
- Total protein and protein fractions, immunofixation
- Free light chains in the blood and protein in the urine
- Calcium, creatinine, albumin, LDH
- β2-microglobulin for staging
- Bone marrow biopsy and cytogenetics
- Low-dose CT, MRI or PET-CT of the skeleton
Treatment
The hematologist determines the tactics, focusing on age, concomitant diseases and the results of genetic research. The basis of modern treatment is a combination of several groups of drugs: proteasome inhibitors, immunomodulators, monoclonal antibodies and hormones, which are prescribed in courses. Patients without severe concomitant diseases can undergo a transplantation of their own stem cells after achieving a response. Separately, medications that strengthen bones, pain relief, and supportive care are prescribed. In the asymptomatic form, observation is sometimes chosen.
- Course combination drug therapy
- Transplantation of your own stem cells
- Bone protection drugs
- Radiation therapy to a painful lesion
- Calcium correction and kidney function support
- Infection prevention and vaccination
- Pain relief and rehabilitation
Observation and quality of life
Myeloma progresses like a chronic disease: periods of remission are replaced by exacerbations, and treatment is resumed according to a new regimen. Therefore, regular monitoring of tests is important, allowing you to notice the return of the disease before complaints. The patient is advised to take care of the spine, but not to give up all possible activity: moderate load preserves muscles and bone. You need to drink enough fluids, be careful with painkillers that affect the kidneys, and promptly treat infections. Psychological support and family assistance are part of the therapy.
- Regular monitoring of tests and paraprotein levels
- Drinking enough and taking care of your kidneys
- Avoid heavy lifting and sudden twisting
- Vigorous physical activity and therapeutic exercises
- Vaccination as recommended by a doctor
- Early referral for new back pain
- Psychological support for the patient and loved ones
