Mielomul multiplu: progrese recente în diagnostic și tratament (Review integrativ)
DOI:
https://doi.org/10.52673/18570461.25.4-79.05Cuvinte cheie:
mielom multiplu, etiologie, patogeneză, epidemiologie, clasificare, diagnostic, complicații, tratrament medicalRezumat
Mielomul multiplu este o formă rară și deosebit de agresivă de neoplazie hematologică, având câteva trăsături distincte care îl diferențiază din perspectiva abordărilor terapeutice de alte neoplazii maligne. Diagnosticul mielomului multiplu este adesea dificil, în unele cazuri aproape imposibil, iar investigațiile multimodale au un rol esențial. Simptomele nespecifice contribuie la un diagnostic tardiv și la un prognostic adesea nefavorabil, în special în formele avansate. La prezentare, pacienții manifestă anemie de origine necunoscută (73%), durere osoasă (51-58%), fatigabilitate (32-59%), somnolență (36%), hipoestezie sau parestezie (33%), crampe musculare (31%), constipație (28%), edem periferic (26%), insomnie (25%). Conform ghidurilor contemporane, diagnosticul mielomului multiplu este bazat pe următoarele teste: 1) caracteristicile lanțurilor grele și ușoare; 2) cuantificarea imunoglobulinelor (IgG, IgA și IgM); 3) evaluarea leziunilor osoase litice; 4) evaluarea funcției medulare şi infiltratului plasmocitar; 5) detectarea componentei monoclonale (M) prin evaluarea proteinelor serice şi/sau urinare. Deși s-au înregistrat progrese semnificative, managementul mielomului multiplu continuă să reprezinte o provocare terapeutică majoră. În plus, s-au efectuat mai multe studii retrospective și prospective cu scopul de a identifica factorii de risc, de diagnostic și tratament, inclusiv prin utilizarea unor medicamente noi cu țintă moleculară (imunomodulatorii – talidomida, lenalidomida, pomalidomida), inhibitorii de proteazom (bortezomib, carfilzomib, ixazomib) și anticorpi monoclonali anti-CD38 (daratumumab, isatuximab, elotuzumab), care au optimizat strategiile de tratament și au ameliorat ratele de răspuns, supraviețuire și prognostic al pacienților cu mielom multiplu. În ultimul deceniu, ponderea pacienților care beneficiază atât de terapie de primă linie cu remedii noi, cât și de transplant autolog de celule stem s-a dublat, iar utilizarea chimioterapiei s-a redus. Astfel, noile remedii au transformat mielomul multiplu într-o boală cronică, caracterizată prin multiple recidive și remisiuni, mai degrabă decât o afecțiune incurabilă.
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