By prevalence in the Amur region MM is located on the 5th place . In the general structure of hemoblastosis MM takes 9.8%. Since the mid-1990s, there has been an increase in the incidence of MM, if in 1994 it was 0.5 per 100,000 of the population, then in 2004 it was 1.7 per 100,000 of the population. The average annual incidence of MM for the period studied was 1.4 per 100,000 population. The distribution of patients with MM by age at the time of detection of the disease is presented in Table 23. The average age is 57 ± 5.8 years. There was a slight predominance of men over women (52 and 48%, respectively).

In the study of immunochemical variants of MM, it was found that myeloma G is most often detected – 72 people (58.5% of the total number of patients with MM), less often Myeloma A – 27 people (22%), Bens-Jones myeloma – 11 people (9% ), non-secretory myeloma – 1 3 patients (10.5%) .

The study of clinical and anatomical features of myeloma showed that diffuse – focal (80 people – 65%), diffuse (18 people – 14.6%) and multiple – focal (16 people – 13%) forms of MM . Solitary myeloma was diagnosed in 8 patients (6.5%). The diagnosis of predominantly visceral form of MM is made for 1 patient (0.9%).

When diagnosing the disease, 31 patients (25.1%) were diagnosed with stage IA, 12 (9.8%) stage IIA, 55 (44.7%) stage IIA. In 25 patients at the time of diagnosis, myeloma nephropathy was detected, complicated by chronic renal failure: IB stage was diagnosed in 3 (2.4%), IIB in 5 (4.1%), IIIB in 17 (13.9%) patients (table 24). Staging was carried out according to the B. Durie and S. Salmon classification [310].

For the treatment of solitary myeloma, radical surgical or / and radiation treatment was used, chemotherapy was not performed. Further, in 4 patients , generalized myeter myeloma was noted . In 10 patients with “smoldering ” myeloma , a waiting tactic prevailed . When signs of growth of the tumor mass appeared, chemotherapy was prescribed. The life expectancy of patients with “smoldering” myeloma is 10–15 years.

For patients with stage I, the median survival was 79 months, regardless of the treatment protocol. In the group of patients with stage IIA, the median survival was 47.6 months for patients treated with the MP protocol, for patients treated with the 1st line polychemotherapy protocols (M 2 -VBMCP, AVBMCP, VMCP / VBAP, ABCMP, CBMP, AVMP, ABCM) 53 months. In the group of patients with stage IIIIA, the median survival was 33.9 months for patients treated with the MP protocol – 50 months for patients treated with the 1st line polychemotherapy protocols. Since the polychemotherapy protocols of the reserve (VAD, VAMP, VCAD, CEVAD, pulsotherapy with dexamethasone, etc.) were performed in patients with aggressive MM with primary and secondary resistance to other protocols, the survival rate of such patients rarely exceeded 36 months.

Since the spring of 2006, Velcade (bortezomib) has been used in the hematology department of the Amur Regional Clinical Hospital for the treatment of recurrent and resistant forms of MM. As a second-line therapy, treatment with this drug was carried out in 20 patients with MM. In 13 cases, a recurrence of the disease occurred, in 7 patients, primary resistance to therapy was ascertained. In 17 cases, IIIA occurred, in 3 cases, stage IIIB (according to B. Durie and S. Salmon, 1975). The duration of illness of patients taken for bortezomib treatment ranged from seven years to six months. Depending on the age and somatic status of the patients, velcade was administered both as monotherapy and in combination with other cytostatics — VMP protocols (velcade, melphalan, prednisolone), Velc + dexa (velcade and dexamethasone),PAD (velcade, dexamethasone and adriablastin). All patients are currently undergoing the necessary treatment. In 4 patients, a fatal outcome was noted due to the progression of the underlying disease. In 10 patients managed to reach the phase of “plateau”. In 6 patients, complete remission of the disease was achieved. Complete remission in MM patients, prior to the use of velcade, during chemotherapy, was achieved extremely rarely, in most cases only after autologous bone marrow transplantation. It is particularly encouraging that complete remission was achieved in patients with a disease duration of more than 5 and 7 years. Combineddue to the progression of the underlying disease. In 10 patients managed to reach the phase of “plateau”. In 6 patients, complete remission of the disease was achieved. Complete remission in MM patients, prior to the use of velcade, during chemotherapy, was achieved extremely rarely, in most cases only after autologous bone marrow transplantation. It is particularly encouraging that complete remission was achieved in patients with a disease duration of more than 5 and 7 years. Combineddue to the progression of the underlying disease. In 10 patients managed to reach the phase of “plateau”. In 6 patients, complete remission of the disease was achieved. Complete remission in MM patients, prior to the use of velcade, during chemotherapy, was achieved extremely rarely, in most cases only after autologous bone marrow transplantation. It is particularly encouraging that complete remission was achieved in patients with a disease duration of more than 5 and 7 years. Combinedin most cases, only after autologous bone marrow transplantation. It is particularly encouraging that complete remission was achieved in patients with a disease duration of more than 5 and 7 years. Combinedin most cases, only after autologous bone marrow transplantation. It is particularly encouraging that complete remission was achieved in patients with a disease duration of more than 5 and 7 years. Combinedtherapy was much more effective than bortezomib monotherapy. Of the 6 patients in whom complete remission was achieved, four received combination therapy.

Since June 2008, in the hematology department of the Amur Regional Clinical Hospital, Velcade has been used as a first-line therapy in combination with other drugs (protocols VMP, Velc + dexa, PAD). To date (September 2009), 7 patients have been assigned as first-line therapy. In all patients, therapy started in stage IIIA of the disease. Complete remission was achieved in 2 and partial remission in 3 people, the minimum response in one patient. In this case, three patients have not completed the full course of treatment. Only one patient admitted to the ward with the presence of multiple visceral lesions has a progression of the disease.

All patients had two side effects of the drug: peripheral sensory neuropathy of the 2nd and 3rd degrees and thrombocytopenia. More rarely, they were diagnosed: intestinal paresis, exacerbation of chronic pancreatitis, reduced visual acuity. In all patients, the common side effects of chemotherapy were noted – weakness, loss of appetite, and increased fatigue. Complications were amenable to correction, and there was an opportunity to continue therapy.

In this study, there was no registered worse tolerance of polychemotherapy protocols compared to monotherapy with Velcade. However, no protocols containing high doses of dexamethasone (PAD, Velc + dexa) were prescribed to patients with severe cardiovascular diseases and diabetes mellitus. Considering the better and more durable clinical effect of the polychemotherapy courses, compared with Velcade monotherapy, it was concluded that it is advisable to administer combined therapy, including bortezomib, to patients with the first diagnosed MM (except for cases of “smoldering” myeloma), in the absence of severe concomitant pathology.