Multiple myeloma (myeloma, plasmacytoma, mielomatoz) - a malignant tumor that affects the plasma cells, a type of white blood cells. Treatment of multiple myeloma is complex, includes a number of ways.
Advantages of myeloma treatment in Israel, Assuta Hospital:
- Personalized approach to therapy including administration of vaccines, cytotoxic agents, targeted and liposome preparations.
- Genetic testing, which specifies the type of myeloma and increases the likelihood of successful treatment.
- Treatment of metastatic myeloma with minimal impact on the body.
- Employment expert physicians specializing in the treatment of multiple myeloma.
- Clinical trials of new treatments in the MP Assuta.
Prices of myeloma treatment in Israel
Cost of diagnostics - up to ten thousand dollars.
prices for treatment without a transplant of stem cells - up to eighty thousand dollars. Transplant procedure - from sixty to one hundred and forty thousand dollars.
Plasma cells produce immunoglobulins directed at the body's fight against infection. The more plasma cells found in the bone marrow, and in some tissues and organs.
Malignant process is sometimes preceded by a monoclonal gammopathy of unknown origin - a precancerous condition with high risk of developing cancer.
Myeloma develops when abnormal plasma cells begin to divide uncontrollably, filling marrow, counteracting the formation of various blood cells. Furthermore, myeloma cells produce a substance which causes damage to bones and hypercalcemia. It is also able to produce abnormal proteins that affect other organs, such as kidneys.
The disease can be sluggish - "smoldering" and active. In the first case, it is asymptomatic, in the second - showing signs of disease.
Myeloma cells can form tumors in bones. One tumor is called - single plasmacytoma (myeloma), multiple - multiple myeloma. Neoplasms may arise outside of the bone, they are called - extramedullary plasmacytoma.
Myeloma Treatment in Israel
Treatment of multiple myeloma in clinic Assuta employs a team of oncologists who specialize in the field of surgery, radiotherapy, chemotherapy, targeted therapy. They interact with the patient, developing a treatment plan. Deciding on the treatment of multiple myeloma is based on the following factors:
- the presence of symptoms;
- stage of pathology;
- type myeloma;
- plasmacytoma presence of complications;
- the patient's age;
- general state of health of the patient.
Response to treatment of myeloma classified. Complete response is defined by any of the following:
- Immunofixation (specialized type of electrophoresis, which identifies the type M-protein) does not detect the M-protein in the blood or urine.
- Disappears extramedullary plasmacytoma.
- Plasma cells constitute less than 5% of bone marrow cells.
Very good partial response (VGPR) is determined by any of the following:
- Immunofixation is M-protein in the blood or urine, but it is not detected by the standard electrophoresis.
- M-protein in the blood is reduced by 90 percent or more. M-protein in the urine is less than 100 mg within 24 hours.
Partial response (PR) is set when:
- M protein is reduced by 50% or more. M-protein in urine decreases by more than 90% within 24 hours or less to 200 mg over 24 hours. If the blood or urine can not be measured M protein, determined by free light chain of immunoglobulin in serum and urine in the morning (Bence-Jones protein).
- Extramedullary plasmacytoma reduced by more than 50%.
Progression of the disease is established using one or more factors:
- M protein increased by 25% or more in blood or urine, the percentage of plasma cells in the bone marrow increased by 25% or more, or to increase both these quantities.
- There are new bone lesions or plasmacytomas.
- Patients have hypercalcemia (high blood calcium levels), provoked by myeloma.
Stable disease is chronic or discrepancy criteria for a complete response, partial and good partial response.
For the treatment of multiple myeloma following treatment methods are used in Israel - chemotherapy, stem cell transplantation, radiotherapy, surgery, supportive therapy and follow-up.
Methods of treating various types of myeloma
Myeloma affects bone marrow and a few bones or bones in a number of areas. Therefore, it is considered to be widespread at diagnosis. plasmacytoma treatment due to the presence or absence of the patient's symptoms.
Asymptomatic myeloma ( "smoldering")
Watchful waiting is usually offered with indolent myeloma. Doctors closely watch the development of the disease. Treatment is prescribed when the symptoms of the disease develop.
Active or symptomatic multiple myeloma
The patient observed symptoms characteristic of this disease. therapy program determined considering unique characteristics of the disease may include chemotherapy, stem cell transplantation, radiotherapy, maintenance treatment of myeloma.
This is a special type of multiple myeloma, which develops in the body's soft tissues. Basic plasmacytoma treatments - irradiation and operation aimed at tumor removal.
Relapse and refractory multiple myeloma
Relapse of disease return means after treatment, refractory myeloma - lack of response to therapy.
As a relapse and refractory multiple myeloma requires further treatment and monitoring. Treatment options include watchful waiting, chemotherapy, targeted therapy, use of corticosteroids, stem cell transplantation, maintenance therapy.
Chemotherapy myeloma in Assuta
Chemotherapy - one of the basic methods of treatment of multiple myeloma. It involves the use of cytotoxic drugs for cancer treatment. Most often therapy is systemic. Chemotherapy is recommended:
- as a primary myeloma treatment to destroy tumor cells;
- before transplanting stem cells in order to reduce the content of abnormal cells in the body (induction therapy);
- as a high-therapy in a consolidation phase;
- after transplantation to reduce the risk of recurrence or try to achieve a complete remission (maintenance therapy);
- for the treatment of recurrent or refractory myeloma;
- to control symptoms of the disease, relieve symptoms as palliative therapy.
The most common drugs:
- Melphalan (Alkeran, L-PAM), it is often given with prednisone or dexamethasone, usually within 4 days, repeated every 28 days.
- Cyclophosphamide (Cytoxan, Procytox), are often prescribed with prednisone. If prescribed orally - the weekly, if intravenously - daily for 4 days (rarely).
The most common chemotherapy combinations used to treat multiple myeloma:
- VAD - vincristine (Oncovin), doxorubicin (Adriamycin), dexamethasone.
- DVD - dexamethasone, vincristine, doxorubicin.
- D-PACE - dexamethasone, cisplatin, doxorubicin, cyclophosphamide, etoposide.
Induction therapy - this is the first stage of the treatment of multiple myeloma in Israel. The main task - to reduce the number of abnormal cells in the bone marrow and protein content, which produce the cancerous cells. Induction therapy usually lasts 3-4 weeks.
This type of treatment prescribed to patients with active multiple myeloma. This is the first stage of treatment prior to high-dose chemotherapy. Induction therapy may include chemotherapy, targeted therapy, and corticosteroids.
Induction therapy for candidates for stem cell transplantation
Candidates are patients sixty-five years of age and younger, generally have good health. Implemented induction therapy followed by high-dose chemotherapy (consolidation phase). Induction therapy includes 3-4 cycles, it is not carried out to achieve complete remission. This helps to reduce organ damage that may result from exposure to certain drugs.
Induction therapy in this case may include:
- Dexamethasone (Decadron, Dexasone)
- thalidomide (Thalomid) and dexamethasone
- bortezomib (Velcade) and dexamethasone
- lenalidomide (Revlimid) and dexamethasone
- VAD: dexamethasone, vincristine, doxorubicin.
High-dose chemotherapy is given after induction therapy and stem cells before transplantation.
Candidates for transplantation therapy is not indicated with melphalan, which can reduce the number of stem cells that create difficulties for collecting a sufficient number of cells for transplantation. This drug may prescribe, if you plan to allogeneic transplantation.
Induction therapy for patients who may not be candidates for stem cell transplantation
In this case, apply all of the above drugs. In addition, the following cytotoxic agents can be assigned:
- MPT: melphalan (Alkeran, L-PAM), prednisone, thalidomide.
- MPB: melphalan, prednisone, bortezomib.
- DVD: doxorubicin, vincristine, dexamethasone.
Consolidation phase in multiple myeloma
Consolidation phase follows after induction therapy. It involves high-dose chemotherapy and stem cell transplantation. Standard preparation used melphalan (Alkeran L-PAM).
Supportive therapy plasmacytoma
It is usually prescribed after autologous transplantation of stem cells. Myeloma treatment continues for a long time, to maintain remission - more than 1 year, but may be longer if the disease progresses.
Among the potential side effects of chemotherapy note:
- bone marrow suppression;
- loss of appetite, change in taste;
- vomiting and nausea, diarrhea, and constipation;
- changes of the skin;
- Cushing's syndrome (fluid retention, weight gain, increased appetite, symptoms of diabetes, unusual hair growth) due to reception of corticosteroids;
- vision problems;
- blood clots;
- damage to organs (heart, kidney, lungs, the nervous system);
- serious birth defects when taken cytostatic agents during pregnancy.
Targeted therapy - new in the treatment of multiple myeloma in Israel
This is a new method of treating multiple myeloma in Israel. The drug is delivered directly into the cancer cell, thereby limiting its effect on healthy cells.
The most common targeted therapies for multiple myeloma
Targeted therapy - is the main form of maintenance therapy. Description used for this purpose drugs.
Recent studies have shown that it helps to prevent relapse, but can cause serious side effects.
One new class of drugs - proteasome inhibitors. Bortezomib block the proteasome - enzymes in all cells, which play an important role in the regulation of cellular functions and growth. Such interference in the function of the proteasome results in apoptosis - the death of cancer cells and stop the development of the disease. To improve the efficiency bortezomib is combined with the following chemotherapeutic agents:
- melfalanom and prednisone;
Bortezomib is given by injection. Such a form unsuitable for long-term use.
During the reception, bortezomib can not drink green tea because it blocks the activity of the drug.
Thalidomide inhibits the development of tumor neovascularization, influencing chemicals which the cells are used to signal each other. Also thalidomide is an immunomodulatory agent that interferes with the growth and division of plasmacytoma cells. For the treatment of multiple myeloma, thalidomide is often combined with melphalan and prednisone or dexamethasone. At this time, it is used less often because of the recent research results have not confirmed an increase in survival. Also revealed a lower quality of life, as compared to other medications maintenance therapy.
Lenalidomide works in a similar manner as thalidomide. For the purpose of treating the recurrence of the disease it can be combined with dexamethasone.
Pomalidomid similar to thalidomide and lenalidomide medicament. It can be combined with dexamethasone, if not previously been treated with bortezomib and lenalidomide.
This steroidal hormones, which act as anti-inflammatory agent, reducing the swelling by reducing the immune response (an immune system response to the presence of foreign substances). Sometimes corticosteroids are used with or instead of targeted therapy in the maintenance treatment of myeloma. The most common corticosteroids - dexamethasone and prednisone.
Corticosteroids reduce side effects of chemotherapy. If the patient is too ill to undergo chemotherapy to treat assigned only dexamethasone.
Stem cell transplantation in the treatment of myeloma in Israel
Stem cell used in the treatment of multiple myeloma. The procedure allows to restore stem cells damaged by disease or high-dose chemotherapy or radiation.
Stem cells - are the basic cells that are found in bone marrow and in the blood, based on them are all the other blood cells.
Previously, the bone marrow was the most common source of stem cells for transplantation. Now, more often such as resource use peripheral stem cells.
Transplant procedure is considered in the following cases:
- As a first-line treatment for people aged 65 years or younger with general good health.
- In relapsed or refractory multiple myeloma.
types of transplant
There are three basic types of transplants:
- Autologous when stem cells taken from their own bone marrow or blood. In multiple myeloma is a preferred type of transplant for most people over 50 years old. Sometimes the procedure is repeated after 6-12 months.
- Syngeneic transplant involves taking stem cells from a donor - the patient's twin.
- Allogeneic transplantation is considered experimental in multiple myeloma. Mainly carried out in the framework of a clinical trial. Stem cells are taken from a donor and passed to the recipient. The donor may be a relative or not. Selection of a donor by using HLA-typing. The use of allogeneic transplantation is limited to the need to find a compatible donor and the undesirable consequences of treatment, too heavy for patients older than 50 years. Sometimes used low doses of cytostatic agents, which gives an opportunity to transplant the elderly. The procedure is less toxic and is called a mini-transplant.
Transplant procedure - a very complex and carries a high risk. Therefore, it is carried out in specialized centers or hospitals by a team of highly qualified doctors.
There are three stages transplant:
- Preparation. It carried out a series of procedures to determine that the patient is a good candidate. Collect stem cells for transplantation.
- Transplantation procedure itself involves 2 steps. The patient receives high-dose chemotherapy. Thereafter, in its body through a central venous catheter is administered the stem cells.
- Care. After the transplant, require special care, so the patient stays in the clinic for 2-3 weeks. As it is under close supervision after discharge. It may take a few months until people recover after transplantation.
Possible side effects of treatment for myeloma include:
- high risk of infection;
- reaction "graft versus host";
- obliterative disease;
- problems with the digestive system;
- skin rashes, hair loss;
- inflammation of the parotid gland;
- engraftment syndrome;
- capillary leak syndrome;
- lung problems (edema, pneumonia, obstructive pulmonary disease);
- irregularities in the kidney;
- transplant rejection;
- nerve and muscle problems;
- children problems in the development and growth;
- damage to the bladder;
- fertility problems;
- the risk of developing another type -melanomy cancer, bone cancer, sarcoma, lymphoma, and some others.
Radiation therapy in the treatment of multiple myeloma in Israel
Radiotherapy with plasmacytoma apply:
- as a primary treatment for a solitary plasmacytomas bone or extramedullary plasmacytoma;
- in combination with chemotherapy or separately for the destruction of myeloma cells;
- to prevent bone fracture or spinal cord compression (together with radiotherapy or surgery alone is often used to treat spinal cord compression);
- to ease the pain of bone fractures or control the symptoms of metastatic multiple myeloma.
Treatment of multiple myeloma in Israel is usually done by external beam radiation therapy. Linear accelerator directs radiation to the tumor and some surrounding tissue. External radiotherapy can be given for the whole body in preparation for a stem cell transplant. This procedure is called - the total body irradiation.
Surgery in the treatment of multiple myeloma in Israel
Sometimes surgery is used to treat myeloma:
- to support the weak and broken bones;
- to cure the disease potentially by the complete removal of the tumor;
- for emergency treatment of spinal cord compression.
Type of transaction due to the size of the tumor and other factors - age and general health. Side effects depend on the type of surgical procedure.
Surgical intervention can prevent and treat bone fractures weakened. Metal plates or rods are placed in the area of the leg bones, arm, spine, pelvis.
innovative methods for fractures of the bones of the spine are used in the clinic Assuta:
- Vertebroplasty involves the introduction of a special type of cement in a broken vertebra to stabilize it.
- Kyphoplasty - a technique balloon placement in the destroyed area of the vertebra to pick it up. special cement is introduced for stabilization.
Compression of the spinal cord
In the case of spinal cord compression can be carried out emergency surgery to stabilize the spine and relieve compression of the spinal cord.
removal of the tumor
For the treatment of extramedullary plasmacytomas applied surgery if they are located in areas where there is the possibility of their removal.
Supportive therapy for multiple myeloma in Israel
Multiple myeloma and its treatment can lead to other health problems. Specialized treatment is applied to prevent or control these complications:
- growth factors (epoetin, darbepoetin) to facilitate the symptoms of anemia and increases the synthesis of new blood cells.
- Bisphosphonates that slow destruction of bone tissue.
- Antibacterial therapy for the prevention and treatment of infections.
- Dental care before taking bisphosphonates.