Diagnosis and principles of therapy of multiple myeloma


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Abstract

MULTIPLE MYELOMA (MM) IS A MALIGNANT TUMOR CHARACTERIZED BY BONE MARROW INFILTRATION WITH CLONAL PLASMA CELLS AND THE SECRETION OF MONOCLONAL IMMUNOGLOBULIN DETECTED IN SERUM AND/OR URINE. MORPHOLOGICAL VERIFICATION ASSUMES THE NEED TO DIAGNOSE >10% OF CLONAL PLASMOCYTES IN BONE MARROW ASPIRATE OR CONFIRMATION BY HISTOLOGICAL EXAMINATION OF THE PLASMACYTOMA BIOPSY SAMPLE. IN ADDITION, ONE OR MORE EVENTS THAT DETERMINE THE MYELOMA, INCLUDING CRAB SYMPTOMS, IS NECESSARY, OR ANY MARKER OF BIOLOGICAL MALIGNANCY (≥60% OF CLONAL PLASMA CELLS IN THE BONE MARROW; THE RATIO BETWEEN INVOLVED AND UNINVOLVED FREE LIGHT CHAINS OF IMMUNOGLOBULINS [FLC] ≥100; OR THE PRESENCE OF MORE THAN ONE LYTIC FOCUS ACCORDING TO MRI DATA). SYMPTOMATIC MM IS PRECEDED BY PRE-MALIGNANT STAGES, SUCH AS MONOCLONAL GAMMAPATHY OF UNDETERMINED SIGNIFICANCE (MGUS) AND SMOLDERING MULTIPLE MYELOMA (SMM), WHICH DO NOT REQUIRE TREATMENT. IN THE LAST DECADE, SIGNIFICANT PROGRESS HAS BEEN NOTED IN THE INDIVIDUALIZATION OF THERAPY FOR PATIENTS WITH MM. HIGH-DOSE CHEMOTHERAPY FOLLOWED BY AUTO HEMOPOLETIC STEM CELL TRANSPLANTATION (AUTOHSCT) IS CRITICALLY IMPORTANT. NEW CLASSES OF DRUGS, SUCH AS PROTEASOME INHIBITORS (BORTEZOMIB) AND IMMUNOMODULATORS (LENALIDOMIDE), ARE INCLUDED IN MODERN INDUCTION REGIMENS THAT PRECEDE TRANSPLANTATION. AFTER AUTOHSCT, PATIENTS WITH STANDARD RISK ARE TREATED WITH MAINTENANCE THERAPY USING LENALIDOMIDE, IN CASE OF HIGH RISK - USING BORTEZOMIB. PATIENTS WHO ARE NOT CONSIDERED AS CANDIDATES FOR AUTOHSCT GAIN THE MAXIMUM BENEFIT FROM LENALIDOMIDE-CONTAINING THERAPY (RD SCHEME), WHICH IS CARRIED OUT UNTIL PROGRESSION. THE ALTERNATIVE IS BORTEZOMIB-CONTAINING VD AND VMP REGIMENS.

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About the authors

S. V Semochkin

FSB El HE "N.I. Pirogov Russian National Research Medical University" of RMH, Department of Oncology, Hematology and Radiation Therapy; SBHCI "City Clinical Hospital № 52 of the Moscow Healthcare Department"

Email: s.semochkin@gmail.com
Doctor of Medical Sciences, Prof at the Department of Oncology, Hematology and Radiation Therapy; Hematologist

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