The defeat of the bronchopulmonary system

Multiple myeloma (MM) is a lymphoproliferative disease, the morphological substrate of which is plasma cells that produce monoclonal immunoglobulin . MM is known as “elderly disease”, the average age at the time of diagnosis is 61 years . MM has a large variety of forms and options. Each of these options has its own clinical manifestations and requires special therapeutic approaches. Klee Niko-anatomical classification is based on radiological examination of the skeleton, morphological analysis of punctates and bone trepanates. Diffuse-focal (60% of observations), diffuse (24%), multiple-focal (15%), sclerosing (<1%), mostly visceral (<0.5%) forms of MM are distinguished. Immunochemical studies of monoclonal secretion of serum and urine Ig determine the immunochemical variant of MM. Myeloma G is the most common (55–65% of all cases of multiple myeloma), myeloma A is in second place (20–25%), Bens-Jones myeloma is in third place (secretion of light chains only) 12–20%), rare forms of the disease are myeloma D, E, M, non-secreting, diclonal myeloma.Depending on the size of the tumor mass at the time of the study there are three stages of MM; An additional feature of all stages, which determines substage (A or B) is the function of the kidneys . Staging MM by B.Durie and S.Salmon (1975) is generally recognized. MM remains an incurable disease . From 20 to 40% of patients are insensitive to chemotherapy treatment (primary resistance), in all patients sensitive to chemotherapy, secondary resistance to previously administered therapy develops at different times . When MM poly- primary pathological secreting IgA resistance occurs in the pa 2 for more than myeloma G . In recent years, an increase in the incidence of MM has been observed throughout the world, only partly due to the success of diagnostics and Life expectancy . With the introduction of melphalan into medical practice, the average life expectancy of a large MM has reached 36 months . Attempts to increase the life expectancy of patients with the help of various polychemotherapy schemes were not crowned with success . High-dose chemotherapy, followed by transplantation of autologous stem cells, is considered the most effective method for treating MM . The use of autologous transplantation allowed us to increase the median survival of myeloma patients to 54.4 months . However, taking into account the age structure of the patients and the complicated somatic status, this method is not applicable to all . Therefore, for a large cohort of patients with MM, even in economically developed countries, standard therapy remains the method of choice . In our country, the majority of patients receive chemotherapy without subsequent transplantation of stem cells . In addition to pathogenetic patience, the program for treating patients with MM includes: for the prevention and treatment of hypercalcemia, the improvement of the repair of bone destruction bisphosphonates ; in the presence of anemic syndrome, erythropoietin ; with a high content of protein in the serum of Crimea, plasmapheresis , etc.

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