What Is Light-Chain Myeloma?
Myeloma is a progressive neoplastic disease characterized by a bone marrow plasmacytoma and an intact single gram
Myeloma - Myeloma (also known as plasmacytoma) is a malignant tumor that originates from plasma cells in the bone marrow and is a more common malignant tumor. There are single and multiple, the latter is more common. Multiple myeloma, also known as multiple myeloma (MM), is caused by malignant changes in plasma cells with synthetic and secretory immunoglobulins. A large number of monoclonal malignant plasma cells proliferate and easily involve soft tissues. Metastases, but few lung metastases. More common in the spine, accounting for 10% of primary spinal tumors, more common in the lumbar spine. The ratio of men to women who are more than 40 years old is about 2: 1. It is more common in men over 40 years of age, and the most common sites are spine, ribs, skull, and sternum.
- Lu Jin
- Secretary-General of Hematology Branch of Beijing Physician Association, Chief Physician of Pediatrics People's Hospital. Expert reminder
1. Multiple myeloma is a common hematological malignancy.
2. Bone pain is the most common symptom of multiple myeloma.
3. Patients with no symptoms or no progression of symptoms need only monitor the condition and do not need treatment.
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Myeloma etiology
- Myeloma is a progressive neoplastic disease characterized by a bone marrow plasmacytoma and an intact single gram
- Myeloma
- Possible causes are ionizing radiation, exposure to industrial or agricultural poisons, and chronic infections, chronic antigenic stimuli, genetics, and cytokines such as IL-6. Among the survivors of the atomic bombing in Japan, the incidence and mortality of myeloma have increased. The disease can occur on the basis of chronic osteomyelitis, pyelonephritis, tuberculosis, chronic hepatitis, and autoimmune diseases, because chronic chronic infection can be manifested as lympho-reticular hyperplasia, autoimmune reactions, and hypergammaglobulinemia.
Myeloma diagnosis
- The auxiliary examination usually has progressive anemia, and the erythrocyte sedimentation rate increases significantly. Increased serum calcium in some patients, often accompanied by
- Myeloma
Myeloma main symptoms
- Myeloma is a persistent spinal pain that progresses progressively. Multiple patients have a wide range of pain. About 40% to 50% of patients are associated with pathological fractures. Prone to paraplegia and nerve root compression symptoms. Generally, there is progressive anemia, and the erythrocyte sedimentation rate increases significantly. Some patients have elevated serum calcium, often accompanied by secondary hyperparathyroidism. Total serum protein increased. Globulin is increased, albumin is reduced or normal. Serum protein electrophoresis mostly has abnormal immunoglobulin peaks. Urinary protein is often positive, but the positive rate of this week protein is not high, about 30% to 60%. At the same time, calcium oxalate crystals and alkaline phosphate in urine increased. Bone marrow smears show a proliferative bone marrow image, with plasma cells occupying at least 8% of nuclear cells.
Myeloma detailed symptoms
- Myeloma is a multiple malignant intramedullary tumor that occurs in middle and old age (40-60 years). Vertebra, ribs, chest
- Myeloma
Myeloma symptoms and signs
- Many clinical manifestations
- Myeloma
- (A) manifestation of tumor cell infiltration
- 1. Bone pain, bone deformation, and pathological fractures: Myeloma cells secrete osteoclast active factors to activate osteoclasts, solubilize and destroy bone. Bone pain is the most common early-onset symptom, accounting for about 70%, mostly lumbosacral , Sternum, ribs pain. Due to the destruction of bone by tumor cells, pathological fractures can occur, and multiple fractures can exist at the same time.
- 2. Anemia and bleeding: Anemia is more common and is the first symptom. It is mild in the early stage and severe in the later stage. Thrombocytopenia, bleeding symptoms are more common, skin and mucous membrane bleeding are more common, and visceral and intracranial bleeding are severely seen.
- 3 Liver, spleen, lymph node and kidney infiltration: mild, moderate enlargement of liver, spleen, lymph node enlargement of neck, myeloma and kidney.
- 4 Other symptoms: Some patients may experience limb paralysis, drowsiness, coma, diplopia, blindness, and vision loss in the early or late stages.
- (B) Symptoms caused by myeloma cells secreting a large amount of M protein
- 1. Secondary infections are more common in bacteria, and fungi and viruses are also seen. The most common are bacterial pneumonia, urinary infections, and sepsis. Viral zoster is also visible.
- 2. Renal function damage 50% -70% of patients have protein, red blood cells, white blood cells, casts, urine, chronic renal failure, hyperphosphatemia, hypercalcemia, hyperuricemia, and can form uric acid stones.
- 3 The incidence of hyperviscosity syndrome is about 2% to 5%, and dizziness, dazzle, and visual impairment, and sudden syncope and disturbance of consciousness can occur. More common in IgM MM.
- 4 The incidence of amyloidosis is 5% -10%, which often occurs in the tongue, skin, heart, gastrointestinal tract and other parts.
- (3) Plasma cell leukemia is consistent with peripheral plasma cells greater than 20%, hepatosplenomegaly, and white blood cells greater than 15 × 109 / L.
- Plasma cell leukemia.
- Signs: Patients in stage and see anemia, pale eyelid and conjunctiva, with or without lymphadenopathy, increased heart rate, mild liver and spleen, moderate swelling, tenderness in sternum, ribs, lumbar vertebra, etc. Masses, or pathological fractures, skin ecchymosis with bleeding can be seen, accompanied by lung infections, often wet snoring.
- Common complications: Pneumonia, urinary tract infection, sepsis, renal failure, pathological fracture.
- Laboratory examination can find the following changes: serum globulin is increased in about 50% of cases; serum calcium is increased in about 50% of cases, up to 18 mg%; parathyroid glands in such cases are secondary Hyperplasia; Progressive anemia, which is caused by the destruction of hematopoietic institutions by tumors; Pseudoplasma leukemia may occur in the peripheral blood of a few advanced cases, coagulin is present in feces in 75% of cases, about 70% of cases Nephropathy occurs in advanced stages.
Myeloma clinical symptoms
- Myeloma is a multiple malignant intramedullary tumor that occurs in middle and old age (40-60 years). Vertebral body, ribs
- Myeloma
- The main symptom of myeloma is persistent spinal pain with progressive exacerbations. Multiple patients have a wide range of pain. About 40% to 50% of patients are associated with pathological fractures. Prone to paraplegia and nerve root compression symptoms.
- Generally, there is progressive anemia, and the erythrocyte sedimentation rate increases significantly. Some patients have elevated serum calcium, often accompanied by secondary hyperparathyroidism. Total serum protein increased. Globulin is increased, albumin is reduced or normal. Serum protein electrophoresis mostly has abnormal immunoglobulin peaks. Urinary protein is often positive, but the positive rate of this week protein is not high, about 30% to 60%. At the same time, calcium oxalate crystals and alkaline phosphate in urine increased. Bone marrow smears show a proliferative bone marrow image, with plasma cells occupying at least 8% of nuclear cells.
- Myeloma has an indefinite asymptomatic period. A few patients have back pain as the first symptom, accompanied by anemia and cachexia. There are also patients who come to the clinic for pathological fractures.
- Visible signs and symptoms in the elderly
- 1. Neurological symptoms are only seen in a few patients such as paralysis caused by spinal cord compression, nerve root pain and defecation disorders; amyloidosis infiltrates peripheral nerves and causes carpal tunnel syndrome; high viscosity causes headaches, weakness, Visual impairment and retinopathy.
- 2. If M-protein forms cold globulin, Raynaud's phenomenon, circulatory disturbance and gangrene can occur. The incidence of amyloidosis in China is only about 7%, which is manifested as giant tongue, enlarged heart dysfunction, arrhythmia, and renal dysfunction. Lymph nodes or hepatosplenomegaly are rare.
- 3. The clinical staging is currently using the staging method proposed by Durie & Salmon in 1975. According to various factors related to prognosis before treatment (hemoglobin, calcium, M-protein amount, and bone involvement), the overall tumor burden is estimated: Phase I): <0.6 × 1012 cells / m2; moderate load (phase II): (0.6 1.2) × 1012 cells / m2; high load (phase III):> 1.2 × 1012 cells / m2. According to renal function, each period is divided into: "A" serum creatinine <177 mol / L (2mg / dl); "B" serum creatinine> 177 mol / L (2mg / dl). The median survival time for stage is> 60 months, and the median survival times for stage and are 43 months and 23 months, respectively. Patients with IA generally do not need treatment and should be closely observed to determine whether it is progressive myeloma. According to the obvious clinical symptoms and gradual increase of M-protein and the appearance or increase of proteinuria this week.
Myeloma solitary myeloma
- Solitary myeloma accounts for about 3% of myeloma. The lesion only invades a certain part of the bone, causing local pain. Most patients were free of anemia, hypercalcemia, and renal insufficiency. About one quarter of patients have lower M protein levels in serum or urine (<15g / L). Normal immunoglobulins are not suppressed. Plasma cells did not increase in the bone marrow invasion site. The diagnosis relied on local histological diagnosis to confirm that X-ray examination may have local skeletal changes, but no systemic bone destruction. After treatment of local lesions, serum and urine M proteins disappeared.
Types of myeloma
- Human immunoglobulin (abbreviated as Ig in English) is composed of two heavy chains and two light chains. According to the name of the heavy chain, it is named IgG, IgA, IgD, IgE, and IgM. There are only two kinds of light chains, namely, light chain . And light chain . The type of myeloma is named after the type of abnormal immunoglobulin produced by myeloma cells. The most common types are IgG and IgA. Monoclonal IgG or IgA can be detected in patients' blood, and light chain kappa or light chain lambda can also be detected. About 30% of patients can detect light chain ( Light chain or light chain ). About 10% of patients produce only light chains without forming heavy chains, which are called "light chain myeloma"; in rare cases (about 1-2%) myeloma cells produce a very small amount or even no This type of monoclonal immunoglobulin is called "non-secretory myeloma". The "serum free light chain assay" invented in recent years has further improved the sensitivity of the detection method, and can detect a small amount of light chains in most of these cases, providing a diagnostic basis for "non-secretory myeloma".
Stages of myeloma
- Multiple myeloma is usually divided into stages I, II, and III based on hemoglobin, blood calcium, osteolytic lesions, and M protein synthesis rate. Each stage is divided into two stages, A and B, based on the presence or absence of renal impairment . There are other laboratory tests that can be used to determine a patient's prognosis and are also used to stage the disease. Staging is of guiding value for the choice of treatment, the judgment of curative effect, and the prediction of disease prognosis.
Myeloma clinical diagnosis
Myeloma imaging
- X-ray bone examination: The affected bone shows a circular puncture-like defect, with the skull typical. Diffuse osteoporosis and decalcification can also be seen.
- Osteolysis in patients with myeloma
- During x-ray examination, most osteolytic puncture defects and unreactive new bone hyperplasia can be found in the affected bone, which is the characteristic of myeloma. Therefore, more pathological fractures. Compression fractures occur when the vertebral body develops. Pathological fractures of the extremities can cause a small amount of periosteal reactive new bone hyperplasia. The typical x-ray signs of myeloma in the parietal skull are irregularly distributed multiple puncture defects, which can be identified at first sight. However, when the long bones and diaphysis develop, bone destruction is sometimes different, and it cannot be distinguished from osteolytic osteosarcoma or metastasis according to the x-ray picture.
Myeloma Medical Test
- General laboratory inspection
- Generally, there is progressive anemia, markedly increased erythrocyte sedimentation, and serum calcium in some patients, often accompanied by secondary hyperparathyroidism. Total serum protein increased. Globulin is increased, albumin is reduced or normal. Serum protein electrophoresis mostly has abnormal immunoglobulin peaks. Urine protein is often positive, but the positive rate of this week protein is not high, about 30
- Myeloma kidney (picture under the microscope)
- Laboratory inspections revealed several changes:
- (1) Serum globulin is increased in about 50% of cases;
- (2) Increased serum calcium in approximately 50% of cases, up to 18 mg%; secondary hyperplasia of parathyroid glands in such cases;
- (3) Progressive anemia is caused by the destruction of hematopoietic institutions by tumors;
- (4) Pseudoplasma leukemia may occur in the peripheral blood of a few advanced cases,
- (5) 75% of cases have coagulin in feces,
- (6) Approximately 70% of cases develop nephropathy in advanced stages.
- (7) Serum protein electrophoresis: D or helioglobin significantly increased, or a single peak M globulin appeared between p and 7 globulin.
- (8) Immunoelectrophoresis: Most of the increased M globulins were analyzed by immunoelectrophoresis. IgG (about 50% -60%), IgA (about 20% -25%), others are IgD, light chain, and very few are IgE.
- (9) Urinary protein: about 60% -70% of cases can be positive.
- Cytology
- Tumors are rich in blood flow and are dark red or dark red, which is more brittle. A large number of abnormal plasma cells can be diagnosed by bone marrow aspiration. Serum protein increased, A / G was inverted, and protein electrophoresis was abnormal, showing elevated and r globulin. Can appear leukemia blood. Bence-Jones protein is positive in urine in more than 40% of patients. In addition, there are increased blood calcium, abnormal urine protein electrophoresis, and so on.
- Myeloma cells (as seen at low magnification)
- Bone marrow smears show a proliferative bone marrow image, with plasma cells occupying at least 8% of nuclear cells. X-ray examination of myeloma patients: it can be normal, accounting for about 10%. Mainly manifested by extensive osteoporosis and multiple bone destruction. It can be seen that methodic bone density decreases, trabecular bone becomes thinner and thinner, and bone cortex becomes thinner. Localized bone destruction can manifest as oval or irregular bone defects, and a few can also appear as soap bubble-like swelling or sclerosing changes. The tumor usually does not invade the intervertebral disc, so the intervertebral space is normal. Because the tumor can be seen in the foramen magnum, MRI examination should be performed where neurological examination suggests a higher involved segment.
- Myeloma: Myeloma cells occupy more than 10% of nuclear cells. Due to the uneven distribution of lesions in the bone marrow, a single negative cannot rule out the disease.
Differential diagnosis of myeloma
- Diagnosis of typical multiple myeloma cases is not difficult. Mainly based on bone marrow aspiration biopsy, abnormal plasma cell infiltration was found, X-ray films showed destructive changes in bone, and serum protein electrophoresis detected M protein or light chain in urine. Differential diagnosis should be done at the same time as the diagnosis.
- 1. A large number of myeloma cells are found in bone marrow aspiration biopsy. This is the main diagnostic basis. However, plasma cell increase can also be seen in rheumatoid arthritis, tumor metastasis in bone marrow, chronic inflammation and many other diseases, but in these diseases, plasma cells generally do not exceed 10%, and there are no morphological abnormalities.
- 2. Destructive bone changes need to be distinguished from tumor bone metastases, senile osteoporosis, and hyperparathyroidism.
- 3. Hyperglobulinemia is mainly M protein and / or proteinuria (this week's protein can be detected in urine), but M protein and this week's protein can still be found in other diseases such as metastatic cancer, macroglobulinemia, multiple Sarcoma and so on.
Myeloma treatment
- treatment plan
- Chemotherapy and radiotherapy are the main methods. Intramedullary nails can be used for pathological fractures of long tubular bones. In severe cases, they can be amputated. If spinal cord compression caused by spinal bone needles can be used for laminectomy decompression, the prognosis is poor.
- Comprehensive treatment is generally used, with radiotherapy and chemotherapy as the mainstay, supplemented by surgical treatment.
- Radiation therapy for myeloma is moderately sensitive to radiation, with different doses for palliative and radical treatments. Chemotherapy is more extensive, and chemotherapy should be used. Generally, L-phenylalanine nitrogen mustard or cyclophosphamide are commonly used, as well as methylbenzyl hydrazine, dichlorohexyl nitrosourea and vinpocetine.
- If the spinal cord or nerve root is compressed during surgery, decompression should be performed and chemotherapy should be applied at the same time. The prognosis of the disease is poor, and it usually dies within 1 year. It can prolong life after comprehensive treatment.
- CLS biological immunotherapy is the fourth new type of treatment after surgery, radiotherapy and chemotherapy, and it is a powerful supplement to traditional treatment methods. CLS biological immunotherapy has broken through the three major bottlenecks of "incomplete", "easy to relapse" and "large side effects" of traditional tumor treatment. The treatment effect is rapid without any toxic and side effects. In addition, CLS biological immunotherapy and surgical treatment, chemotherapy and radiation therapy together will have a strong complementary effect. The damaged immune system of patients can play a unique role in recovery and reconstruction: combined with surgical treatment to prevent tumor recurrence and metastasis; combined with chemotherapy can prolong life; improve patients' quality of life.
Myeloma preventive care
Myeloma diet living
- The occurrence of myeloma is related to factors such as the environment and diet, so prevent the occurrence of this disease and enhance the patient's physique
- Analysis of myeloma cells in vitro
- The method of traditional Chinese medicine should pay attention to conditioning emotions and prevent the seven emotions from becoming too much, so as to maintain qi and blood flow, balance yin and yang, and prevent disease.
- After illness, maintaining optimism, not angry or sad, and building confidence to overcome disease is an important part of defeating disease. Pay attention to physical exercise, adjust the body from time to time, you can take qigong, Taijiquan and other methods to enhance physical fitness, prevent disease, or cooperate with the treatment of this disease. Pay attention to daily life, work and rest, moderate temperature, cold and avoid evil, especially should be intercourse, to prevent the dark consumption of kidney essence. Should not smoke alcohol, pay attention to diet and nutrition, avoid overeating, eating preferences. Avoid spicy, fatty, and thick products. After the illness, you can choose blood, blood, and reduce splenomegaly.
- should
- 1. Should eat more foods with anti-myelopathy, osteosarcoma, such as kelp, laver, mussel, sea clam, wakame, almond, peach kernel, plum, ginsenoside rh2.
- 2. Bone pain should eat tortoise shell, meat, pangolin, oyster, crab, shrimp, walnut.
- 3. Splenomegaly should eat turtles, loach, moray eel, moray eel, kelp, wakame.
- 4. Anemia should eat pork liver, shiitake mushrooms, sesame, beesmilk, yellow croaker, peanuts, sea cucumber, catfish, abalone.
- avoid
- 1. Avoid tobacco, alcohol and spicy food.
- 2. Avoid mildew, pickled, fried, fatty food.
- 3. Avoid mutton, goose, pig head and other hair products.
Myeloma Home Care
- 1. Rest general patients can exercise properly. Excessive restriction of the body can promote secondary infections and osteoporosis in patients. However, they must not be violently active. They should avoid overloading and prevent falls and injuries. Use waist circumference and splints according to specific conditions. To prevent this from causing poor blood circulation. If the patient consumes due to chronic illness, the body's immune function is reduced, and when complications are prone to occur, bed rest should be taken to reduce activity. When there is bone destruction, absolute bed rest should be taken to prevent pathological fractures.
- 2. In order to prevent pathological fractures, patients should be given a hard bed, and elastic beds should not be used. Keep the patient in a comfortable lying position to avoid injuries, especially injuries caused by falling.
- 3. Dietary care provides a high-calorie, high-protein, vitamin-rich, and digestible diet. Patients with renal insufficiency should be given a low sodium, low protein or wheat starch diet to reduce the burden on the kidneys. If there is hyperuricemia and hypercalcemia, patients should be encouraged to drink more water and maintain a daily urine output of more than 2000ml to prevent or reduce hypercalcemia and hyperuricemia.
- 4. For the elderly bedridden patients with physical inconvenience, they should regularly help to turn over and move gently to avoid causing fractures. The skin under pressure should be given a warm towel massage or physical therapy to keep the bed dry and flat to prevent bedsores.
- 5. Oral care for patients with impaired renal function, due to excessive accumulation of metabolites, some waste into the respiratory tract to produce bad breath, affecting patient appetite, oral care should be done and given 0.05% chlorhexidine solution and 4% sodium bicarbonate Liquid rinses mouth to prevent bacterial and fungal infections.
- 6. Pain care With the progress of the disease, the symptoms of bone pain are difficult to alleviate, and the severity of bone pain varies, mainly occurring in bones rich in red bone marrow, such as ribs and sternum. Nervous roots can appear as a result of compression. Care should be given to the patient and to minimize patient suffering. Especially for the pain caused by physical activity of patients, they should be closely observed and carefully treated. Give an appropriate amount of analgesics according to your doctor's order, and if necessary, give analgesics such as duolidine and morphine. Local radiation therapy can also be performed to reduce symptoms. Patients with neuropathic pain can be given corresponding local closure or physical therapy.
- 7. Anemia care Observe the symptoms of anemia, determine the degree of anemia, and provide corresponding care.
- 8. Prevention of infection This disease is most common with respiratory infections and pneumonia, followed by urinary tract infections. Therefore, the clean air of the ward should be maintained, the temperature and humidity should be appropriate to avoid cold and cross infection, and help patients to change their positions frequently and promptly spit; Hydration and diuresis.
- 9. Chemotherapy Nursing patients should drink plenty of water during chemotherapy, the daily fluid volume should be no less than 3000ml, and the urine should be alkalized, the fluid volume should be accurately recorded, and the water and electrolyte balance should be maintained.
- 10. Psychological nursing guides patients to express their worries, to give them more care and care, to try to ease the patient's mental pressure, to help patients face reality, to get rid of fear, and to stabilize their emotions.