Multiple myeloma: recent progress in diagnosis and treatment (Integrative review)
DOI:
https://doi.org/10.52673/18570461.25.4-79.05Keywords:
multiple myeloma, etiology, pathogenesis, epidemiology, classification, diagnosis, complications, medical treatmentAbstract
Multiple myeloma is a rare and extremely aggressive form of hematologic neoplasm, with several distinct features that differentiate it from other malignant neoplasms in terms of therapeutic approaches. The diagnosis of multiple myeloma is often difficult, in some cases almost impossible, and multimodal investigations play an essential role. The nonspecific symptoms contribute to a delayed diagnosis and often an unfavorable prognosis, especially in advanced forms. Upon presentation, patients may exhibit anemia of unknown origin (73%), bone pain (51-58%), fatigue (32-59%), drowsiness (36%), hypoesthesia or paresthesia (33%), muscle cramps (31%), constipation (28%), peripheral edema (26%), and insomnia (25%). According to contemporary guidelines, the diagnosis of multiple myeloma is based on the following tests: 1) characteristics of heavy and light chains; 2) quantification of immunoglobulins (IgG, IgA, and IgM); 3) evaluation of lytic bone lesions; 4) assessment of bone marrow function and plasmacytic infiltration; 5) detection of the monoclonal component (M) through serum and/or urine protein analysis. Although significant progress has been made, the management of multiple myeloma continues to be a major therapeutic challenge. In addition, several retrospective and prospective studies have been conducted to identify risk factors, diagnostic markers, and treatments, including the use of new molecularly targeted drugs (immunomodulators – thalidomide, lenalidomide, pomalidomide), proteasome inhibitors (bortezomib, carfilzomib, ixazomib), and anti-CD38 monoclonal antibodies (daratumumab, isatuximab, elotuzumab), which have optimized treatment strategies and improved aspects related to response rates, survival, and prognosis in patients with multiple myeloma. In the past decade, the proportion of patients benefiting from both new first-line therapy and autologous stem cell transplantation has doubled, while the use of chemotherapy has decreased. As a result, new therapies have transformed multiple myeloma into a chronic disease, characterized by multiple relapses and remissions, rather than an incurable condition.
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