Multiple myeloma is a tumor, which develops from cells that make antibodies. These are plasma cells, which are altered B lymphocytes. Multiple myeloma affects the bone marrow, displaces normal cells, and disrupts hematopoietic function. This also damages bones, causing pain and fractures. Due to an excess of antibodies in the blood, some patients have their kidneys affected.
Symptoms
Early in multiple myeloma, there might be no symptoms. When signs and symptoms happen, they can include:
Tests and procedures to diagnose multiple myeloma include:
Treatment:
Multiple myeloma is usually treated with drugs.
Chemotherapy used to be the main treatment in the past.
Doctors use the following drugs for multiple myeloma:
Multiple myeloma can rarely be treated with a single drug. Doctors usually use combinations of two or three drugs. If they do not work, oncologists try other options. Sometimes they prescribe four (DCEP), six (DT-PACE), or even seven drugs at the same time to achieve a remission of the disease.
A treatment regimen usually includes maintenance and symptomatic treatment:
Only a small number of patients with multiple myeloma need radiation therapy. In most cases, doctors can achieve a good result with the help of drug therapy alone.
Irradiation can be used in the following cases:
A bone marrow transplant can be used in cases where other treatment options do not work. There are two transplant options:
An autologous transplant is used to treat multiple myeloma. It is safer than an allogeneic one. In addition, patients do not have to look for a donor. Autologous transplantation procedures provide a long-term remission of the disease.
The essence of this treatment option is as follows:
Some doctors recommend their patients with multiple myeloma to have two auto transplant procedures from 6 to 12 months apart. Such an approach is called a tandem transplant. Trials show that they increase the patient's life expectancy, and a relapse-free period as compared to a single transplant. However, this treatment method has a drawback: it causes more side effects. When having your consultation of the oncologist, check with him whether a tandem bone marrow transplant is suitable for you, or is it better to limit yourself to a standard procedure.
An allogeneic stem cell transplant (from a donor) for multiple myeloma is not considered a standard treatment. This can be used as part of clinical trials. This treatment option can be resorted to in the case of disease recurrence after an autologous transplant. The transplantation of stem cells from a donor is more dangerous, since the cells may not survive, and sometimes an immune reaction "graft versus host" occurs. However, if successful, this treatment is potentially more effective. First, donor cells are definitely free of myeloma residues. Secondly, after a successful transplant, the graft-versus-tumor effect is activated, so the remaining malignant cells in the body are destroyed.
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1-Diagnosis:
The program includes:
Required documents
Price from: On request
Type of program: Outpatient
Expected duration of the program: 7 days
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2-Chemotherapy:
The program includes:
How program is carried out
During the first visit, the doctor will conduct a clinical examination and go through the results of previous laboratory tests and instrumental examinations. After that, you will undergo an additional examination, including laboratory assessment of liver and kidney function, ultrasound scan. Based on the received results, the doctor will elaborate the chemotherapy regimen. If necessary, related medical specialists will be involved in the elaboration of a treatment regimen (tumor board).
Chemotherapy is carried out as the day hospital procedure, without mandatory admission to the hospital. After the placement of a venous catheter, you will stay in a comfortable ward. An infusion system will be connected to the catheter, through which the required drug or a drug combination will be administered. All drugs are administered by intravenous drip, slowly, so the total duration of the infusion can be up to several hours. All this time, doctors and nurses will monitor your health condition closely.
After the course of chemotherapy, you will stay under medical supervision in the ward for a few more hours. If your general condition is good, your doctor will allow you to leave the hospital. You will receive the medical report with detailed recommendations regarding further treatment. In the future, you will be able to have a distant consultation with your attending physician and schedule the next course of chemotherapy, if necessary.
Required documents
Price from: on request
Type of program: Outpatient
Expected duration of the program: 5 to 21 days depending on treatment protocol.
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3-Radiotherapy:
The program includes:
How program is carried out
During the first visit, the doctor will conduct a clinical examination and go through the results of previous laboratory tests and instrumental examinations. After that, you will undergo an additional examination, including complete blood count, laboratory assessment of liver and kidney function. Based on the received results, the physician will conduct radiotherapy planning with the help of CT or MRI, make the permanent tattoo marks on the skin and conduct CT simulation to assess the accuracy of the rays and the radiation dose. If necessary, related medical specialists will be involved in the elaboration of a treatment regimen (tumor board).
Radiation therapy is carried out as an inpatient procedure, with mandatory admission to the hospital. Before each session the physician will assess your general condition and the marks on the skin. After that, you will be placed in a shielded radiation therapy room, on a special table.
Each radiation therapy session lasts less than half an hour (including preparation). All this time, doctors and nurses are monitoring your condition, you can communicate with them through a loudspeaker. The procedure is completely painless. Depending on the planned course of treatment, you will have from 1 to 3-5 sessions of radiation therapy a week.
After the completion of the radiation therapy course, you will undergo control examinations aimed at assessing your condition and efficacy of treatment. After that you will receive the medical report with detailed recommendations regarding further follow-up and treatment. In the future, you will be able to have a distant consultation with your attending physician and schedule the next course of treatment, if necessary.
Required documents
Price from: on request
Type of program: Inpatient
Expected duration of the program: 15- 30 days
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4-Bone marrow transplantation:
The program includes:
How program is carried out
During the first visit, the doctor will conduct a clinical examination and go through the results of the available diagnostic tests. After that, you will undergo the necessary additional examination, such as the assessment of liver and kidney function, ultrasound scan, CT scan and MRI.
Also, the doctor will conduct a bone marrow biopsy followed by cytological examination of the harvested material. This will help him to determine the histological features of your bone marrow (in particular, identify HLA system antigens) and the use of a person’s own stem cells. They typically involve harvesting your cells before beginning a damaging therapy to cells like chemotherapy or radiation. After the treatment is done, your own cells are returned to your body.
This type of transplant isn’t always available. It can only be used if you have a healthy bone marrow. However, it reduces the risk of some serious complications, including GVHD.
Before the procedure, you will receive chemotherapy, if necessary, in combination with radiation therapy. The course of chemo- or chemoradiation therapy lasts from 2 to 8 days.
The bone marrow transplant procedure is an intravenous infusion, i.e. the healthy bone marrow will be injected through a catheter, intravenously. You will stay in your room during the procedure. A bone marrow transplant is completely painless and does not require anesthesia.
During the period of healthy bone marrow engraftment, you will stay in a sterile ward. This is a necessary precaution because during this time your immune system is very weak and cannot withstand environmental pathogens. The risk of bleeding is also quite high, so you will be advised to avoid mechanical damage.
A relative or other close person may stay in the ward with you. You will not be allowed to go outside the department and leave your ward often. The rehabilitation period can last from 1 to 2 months.
When your complete blood count returns to normal, your doctor will schedule your discharge from the department. You will receive information about the rules that you will need to follow at home, the frequency and type of control examinations, and subsequent treatment measures. You will also receive a detailed medical report, which will reflect the entire course of treatment.
Required documents
Price from: on request
Type of program: Inpatient
Expected duration of the program: 57 days
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