A APM apoia a Campanha Março Borgonha, de conscientização sobre o Mieloma Múltiplo, tipo de câncer desconhecido por grande parte da sociedade médica. Embora a prevalência seja maior em idosos, jovens também podem desenvolver a doença. Durante o mês, divulgaremos informações e entrevistas com especialistas em nossas mídias sociais. Acesse o site da campanha e acompanhe nossos canais!
Author: S Vincent Rajkumar, MD
Section Editor: Robert A Kyle, MD Deputy Editor: Rebecca F Connor, MD All topics are updated as new evidence becomes available and our peer review process is complete.
Multiple myeloma (MM) is characterized by the neoplastic proliferation of clonal plasma cells producing a monoclonal immunoglobulin. These clonal plasma cells proliferate in the bone marrow and often result in extensive skeletal destruction with osteolytic lesions, osteopenia, and/or pathologic fractures. Additional disease-related complications include hypercalcemia, renal insufficiency, anemia, and infections. This topic reviews the overall treatment strategy for patients with MM. Further details regarding the selection of initial therapy, the treatment of relapsed and/or refractory disease, the use of hematopoietic cell transplantation, and the management of complications of MM are discussed separately.
VERIFY THE DIAGNOSIS
The first step in evaluating a new patient with MM is to verify the diagnosis since the premalignant stages of myeloma, namely monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM), may be easily misdiagnosed as MM if one is not careful (table 1 and algorithm 1). As an example, patients with MGUS may have renal failure due to diabetes or hypertension, or have bone lesions from other cancers. Such patients may be misdiagnosed with MM if these findings are incorrectly attributed to the plasma cell dyscrasia. Therefore, every effort should be made to determine whether the observed "end-organ damage" is truly secondary to the underlying plasma cell disorder or to an unrelated process. (See "Multiple myeloma: Clinical features, laboratory manifestations, and diagnosis", section on 'Diagnosis'.)
Unlike persons with MGUS and SMM, all patients with a confirmed diagnosis of MM require treatment. Without effective therapy, symptomatic patients die within a median of six months . In contrast, patients with SMM may remain stable for prolonged periods. As such, if there is doubt about whether the patient has SMM or MM, a reasonable approach is to re-evaluate the patient in two or three months and to delay therapy until the correct diagnosis is evident. The patient should be instructed to monitor for symptoms related to MM and contact the provider immediately should there be a change in his or her condition.
Há nove anos, hematologistas e oncologistas se reúnem anualmente em um simpósio educacional organizado por um hospital brasileiro e outro norte-americano. Durante o Board Review 2015, uma pesquisa foi conduzida entre os participantes e avaliou as diferenças na conduta e opções de tratamento para o mieloma múltiplo (MM).
Several clinical studies have compared single with tandem (also called double) autologous stem cell transplantation (ASCT) as first-line treatment in patients with symptomatic multiple myeloma (MM), one of the leading indications for ASCT worldwide.
A growing population of long-term survivors of myeloma is now accumulating the ‘late effects’ not only of myeloma itself, but also of several lines of treatment given throughout the course of the disease.
Autores: Elaine Cristina Faria Abrahão Machado, Cínthia Mendes, Lissa Sabino de Matos, Caroline Romanelli Tiburcio Zelenika, Marcel Alex Soares dos Santos, Marcela Baraldi Moreira, Bogdana Victoria Kadunc, Ana Helena Kalies Oliveira