Symptomatic therapy during treatment

As a symptomatic therapy in the treatment of MM, plasmapheresis was used with high protein content in serum; with deep anemia transfusion of red blood cell mass, erythropoietin. Local radiation therapy was carried out in the presence of limited tumor nodules in the bones, severe compression syndrome, the threat of pathological fractures. Bisphosphonates were used to prevent and treat hypercalcemia, to improve the repair of bone destruction.

Patients have not established a connection in life expectancy with age less than 70 years, gender, type of monoclonal secretion. Survival of patients primarily depended on the sensitivity of the tumor to chemotherapy and on the stage at the time of detection of the disease. The effect of the following indicators on the overall survival of patients was established: 1) myeloma nephropathy complicated by chronic renal failure (median survival was 16 months); 2) severe pancytopenia, diagnosed in the debut of the disease; 3) mielemia in the debut of the disease; 4) age over 70 years due to the presence of severe concomitant pathology in most such patients and poor tolerance to cytostatic therapy; 5) plasmocytosis in the bone marrow> 40% with unripe plasmablast morphology of plasma cells;6) increase in lactate dehydrogenase (> 300 IU / l), β – microglobulin (> 60 mg / l) in the blood.

The main cause of death in most cases was the presence of myeloma nephropathy, complicated by chronic renal failure (CRF). Less often, death occurred due to the addition of infectious complications, hemorrhagic , anemic syndromes, the presence of concomitant cardiovascular pathology in patients with MM.

Since the majority of patients with MM are patients over the age of 50 years, many have associated comorbidity, often influencing the course of the underlying disease .

Group I consisted of 43 patients with IA and IIA stages of the disease. Patients of this group lacked or had single focal bone destruction, the hemoglobin level was above 85 g / l, normal serum calcium level and a low level of the M-component were observed (Ig G <70 g / l or Ig A <50 g / l; protein BJ <12 g per day). All patients with solitary myeloma and “smoldering myeloma” were included in this group. Analyzing the immunochemical variants of MM patients in group I, 27 patients with myeloma G, 13 with non-secreting myeloma, 2 with myeloma A and 1 with Bence-Jones myeloma should be noted. The average age of patients of group I was 56 ± 4.6 years.

Group II included patients in stage IIIA of the disease (55 people). A pronounced osteodestructive process was characteristic of these patients. The level of the M-component was high: Ig G> 70 g / l or Ig A> 50 g / l; protein BJ> 12 g per day. Characterized by anemia (HB <85 g / l), hypercalcemia. The average age of patients in this group was 58 ± 6.5 years. In the majority of patients of group II, there was a developed clinical picture of MM with the presence of bone marrow, hypercalcemic, anemic, hemorrhagic syndromes, syndromes of increased blood viscosity, antibody deficiency, neurological manifestations, etc. This group included 33 patients with myeloma G, 17 with myeloma A and 5 with myeloma Bens-Jones.

Group III consisted of 25 patients in whom myeloma nephropathy and chronic renal failure (stages IB, IIB, IIIB) had already occurred during the initial diagnosis of MM. The average age of patients in group III was 57 ± 6.6 years. Most of this group included patients in Stage III with multiple bone destruction, severe anemic syndrome, high paraprotein secretion. Only in 8 people the myeloma nephropathy was the leading syndrome, in the absence of a pronounced osteo-destructive process in the bones, satisfactory indicators of red blood and serum calcium level. Group III included 12 people with myeloma G, 8 with myeloma A, and 5 with myeloma Bens-Jones.

The control group consisted of 30 people without hemoblastosis and AML. The 2nd control group included 25 patients with pneumonia. The 3rd control group included 25 patients with COPD.

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