Smouldering multiple myeloma (SMM) is a malignant disease characterized by premature and abnormal proliferation of plasma cells responsible for antibody synthesis in the bone marrow. This process replaces normal hematopoietic cells and disrupts the normal function of the immune system. SMM is usually chronic and can manifest itself with various symptoms, including anemia, increased calcium levels in the blood, impaired renal function, as well as osteoporosis and hyperproduction of monoclonal protein. The final diagnosis is based on clinical, laboratory and radiographic examinations. SMM has a variety of clinical manifestations and is often associated with concomitant diseases and complications, requiring a comprehensive approach to diagnosis and treatment.
History of the disease and interesting historical facts
The history of multiple myeloma research spans over a hundred years. The first mention of this disease was made in 1848 by the French physician Georges Dupuy, who described the clinical characteristics of the pathology. However, it was only in the 1950s that significant progress was made in understanding the etiology and pathogenesis of myeloma. An important step was the discovery of the connection between myeloma and specific changes in the bone marrow, as well as the identification of monoclonal immunoglobulins in the blood serum. Scientific research conducted in the 1970s and 1980s led to the development of new diagnostic methods and treatments, including chemotherapy and stem cell transplantation. To date, multiple myeloma continues to be the subject of intensive research aimed at finding more effective therapeutic approaches.
Epidemiology
According to the World Health Organization, multiple myeloma is the second most common hemorrhagic malignancy after lymphoma. Around 5-6 new cases are registered per 100,000 people per year worldwide. The highest incidence rates are observed among people over 65 years of age, with men falling ill 1.5-2 times more often than women. Also note the geographic variability: countries with a high standard of living have higher incidence rates compared to developing regions. Some studies have found that in North American and European countries, the incidence rate reaches 10 cases per 1,000,000 population per year.
Genetic predisposition to this disease
Research shows that genetic predisposition plays a significant role in the development of multiple myeloma. There are certain genetic changes associated with this disease, including mutations in the TP53, RAS, and MYC genes. In particular, abnormalities of chromosomes 13 and 17 have been identified that may indicate an unfavorable prognosis. In addition, a family predisposition to myeloma has also been documented: patients with a family history of the disease have a 2-3-fold increased risk of developing myeloma. Recording these genetic markers is of great importance for prognosis and choice of treatment tactics.
Risk factors for the development of this disease
Among the risk factors that contribute to the development of smoldering multiple myeloma, the following can be distinguished:
- Age. People over 60 years of age are most susceptible to the disease.
- Gender: The disease occurs more often in men than in women.
- Ethnicity: The disease is more common in African Americans than in Caucasians.
- Type of stress on the body. People working in conditions of exposure to heavy metals and chemical carcinogens have an increased risk.
- Immune disorders: Having other diseases, such as HIV/AIDS, also increases the likelihood of developing myeloma.
Diagnosis of this disease
Diagnosis of smoldering multiple myeloma includes a wide range of methods:
- The main symptoms to look out for include persistent fatigue, bone pain, fractures, anemia, kidney problems and hypercalcemia.
- Laboratory tests: Serum protein level (monoclonal protein level) and Bence Jones urine protein test.
- Radiological tests, including X-rays and MRIs, can help detect bone damage.
- Other diagnostic tests include a bone marrow biopsy to assess the extent of the damage.
- Differential diagnosis is important to exclude other diseases such as lymphoma, ossifying myeloma and osteoporosis.
Treatment
Treatment for smoldering multiple myeloma is multifactorial and may include:
- General treatment that aims to relieve symptoms and improve the patient's quality of life.
- Pharmacological treatment: Standards include the use of drugs such as bortezomib and lomustine, as well as immunotherapeutic agents.
- Surgical treatment that may be indicated to treat osteolysis or provide diagnostic guidance.
- Other treatments include supportive therapy with stem cell transplantation.
List of medications used to treat this disease
Drugs actively used to treat smoldering multiple myeloma include:
- Bortezomib (Velcade)
- Lenalidomide (Revlimid)
- Dexamethasone
- Panobinib (Ninlaro)
- Taprovit (Talvey)
Disease monitoring
Monitoring of smoldering multiple myeloma includes monitoring the level of monoclonal protein and assessing liver, kidney and bone marrow function. The prognosis of the disease depends on the stage at diagnosis, genetic markers and response to therapy. Attention should also be paid to possible complications such as infections, renal failure and osteolysis. Regular examinations can allow adjustment of treatment regimens and ensure more effective therapy.
Age-related features of the disease
The pathology has differences in clinical course depending on the age group. In elderly patients, the disease often proceeds more severely, with a combination of other chronic diseases and an increased risk of complications. At the same time, younger patients (up to 40 years) have a more favorable prognosis, often showing higher sensitivity to therapy and a lower predisposition to the development of late stages.
Questions and Answers
- What are the main symptoms of smoldering multiple myeloma? Major symptoms include fatigue, bone pain, hypercalcemia, anemia and kidney impairment.
- How is smoldering multiple myeloma diagnosed? Diagnosis is based on laboratory tests, bone marrow biopsy and radiological studies.
- What are the possible risk factors for developing the disease? Major risk factors include age, gender, ethnicity, and exposure to chemical carcinogens.
- How is smoldering multiple myeloma treated? Treatment involves a combination of chemotherapy, immunotherapy and supportive care.
- What is the prognosis for patients with smoldering myeloma? The prognosis depends on the stage of the disease and characteristics such as genetic changes.
