As MM progressed, there was a deterioration in the indices of cellular and humoral immunity .

The respiratory function was studied by spirography in 70 patients with MM without concomitant COPD. In half of the patients (35 people), no violations of VFL were detected. These are patients from group I and group II, with a disease duration of 1-2 years, in whom no changes were detected during x-ray examination of the lungs. In 35 patients, moderate violations of VFL were diagnosed: in 10 patients in restrictive mode, and in 25 in mixed types. These are patients of group II, who had a diagnosis of MM more than two years ago, and patients from group III. In all, during the X-ray examination of the lungs, changes in the interstitial type were observed (increased vascular pattern, pneumosclerosis and emphysema). According to spirography, 19 patients with myeloma G, 10 with myeloma A,1 with non-secretive myeloma and 5 people with Bens-Jones myeloma, of whom 15 patients had ESRD. Most of these patients were diagnosed with a small reduction in lung volumes. Reduction of VC was diagnosed in all 35 patients (68.4 ± 2.0% D; P <0.001). In 25 patients, a moderate decrease in FEV was observed. 1 (72.9 ± 2.1; P <0.001).

Reduction of VC indicates a loss of elasticity in the lungs and the development of a restrictive respiratory failure (DN). Increased plasma viscosity, the presence of intravascular protein stasis, and increased protein infiltration into the alveoli lead to the lysis of the elastic framework of the lungs. Dystrophy of the elastic framework and the development of emphysema contributes to impaired blood circulation in the lungs in these patients. The filling of part of the alveoli with paraprotein with MM leads to the shutdown of these alveoli from ventilation and the development of emphysema, which in this case is also of compensatory nature. [57]. This reasoning is also supported by a large number of patients with myeloma A, who have impaired VFL, as myeloma A has a more pronounced hyperviscose syndrome . Specific lymphoid and plasma cell lung infiltration may contribute to the development of restrictive type DN. In chronic kidney disease, an important reason for the development of a restrictive type of DN is the presence of uremic changes in the lungs – uremic pulmonary edema, uremic pneumonitis and calcification. A decrease in the FEV 1 value combined with a decrease in the VC indicates the development of a mixed type of DN. When conducting radiological (including ERTG and CT) and bronchoscopic examinations, no patient had an intrabronchial myeloma growth. Therefore, the decrease in FEV 1 can be attributed to edema, specific lymphoid and plasma cell infiltration, sclerotic changes of the bronchial mucosa, with the addition of CRF to uremic lesions, nephrogenic edema and uremic bronchitis. The above changes are more pronounced in the later stages of MM tumor progression. Therefore, it was not revealed in patients with IA, IIA, or the IIA stage of myeloma with a short tumor duration of any violations of VFL recorded by the method of spirography.