Multiple myeloma is malignancy of the blood plasma cells which are responsible for the production of antibodies. As a result, these cells infiltrate the bone marrow and also lead to massive secretion of immunoglobulins which occur in serum and urine. The infiltration of the bone marrow by plasma cells explains the characteristic bone pain. This condition was first described in 1848.It mostly tends to affect individuals over sixty years of age, though it can occur at a younger age. Men are more affected than women. It is more prevalent in blacks as compared to whites. It accounts for 1-2% of all cancers and 10-15% of blood cancers.
The clinical multiple myeloma manifests with the following symptoms; hypercalcemia which is defined as levels of calcium in the body above normal range, renal failure due to accumulation of the protein antibodies in the kidney, anemia which occurs as a result of failure of the blood system to manufacture red blood cells due to its abnormal inclination to produce the antibody forming cells, and bone lesion.
Studies conducted on this condition have shown some factors which predispose an individual to have multiple myeloma. Such studies indicate factors such as age of more than sixty five years, family history, male gender, black race, type 2 diabetes, obesity, intake of low fish and vegetables, rheumatoid arthritis, autoimmune diseases, Acquired Immunodeficiency Disease (AIDS), chemical exposures and farming as an occupation. The diagnosis of this condition is based on a good clinical history with investigations that involve taking peripheral blood film, performing bone marrow aspirate and immunophenotyping.
Based on the clinical trials done on the therapeutic approach to multiple myeloma, Dr. Rafael Rio gives concluding remarks on the same in which he states that the concept of cure is feasible though currently it remains incurable in majority of patients and secondly, surgical management of the disease is possible in selected patients. The results of the latest research on treatment give four phases of chemotherapy that include induction, intensification, consolidation and maintenance. The therapeutic agents found to be potent include thalidomide, lenalidomide, reylimid, dexamethasone, prednisone, cyclophosphamide, melphalan, doxorubicin, etoposide and cisplatin (Tamayo, Rafael Rios).
In the cases of the clinical trials on management, however, there were established relapses of the supposedly treated disease. This finding is said to have brought about an important area of knowledge concerning multiple myeloma and at the same time it’s an unfortunate factor since it shows poor prognosis. The suggested modes of treatment from clinical research findings support retreatment, introduction of new drugs and stem cell transplant. This was termed as the salvage therapy. However, it’s shown that there is no generally accepted standard therapy for relapsing multiple myeloma.
Amidst the above established facts on management of multiple myeloma, Dr. Rafael Rio gives some clinical approach which should be considered in improving the outcome of this condition. This includes prevention of infections, early diagnosis of the disease, conducting close monitoring, carrying out continuous clinical trials, application of individualized therapy, extensive use of stem cell transplants, use of new agents and new combinations. He gives final conclusion concerning the management approach that in the quest for excellence in the management of this condition, there is need for the translation into the daily clinical practice of the standardized approach to clinical laboratory that is in the current use.
Work cited
Tamayo, Rafael Rios. "Light Chain Multiple Myeloma: A Single Institution Series".
