Multiple myeloma is one of the most common malignancies of the hematologic system. In recent years, rapid progress has been made in the diagnosis, treatment, and efficacy criteria of multiple myeloma due to the emergence of new drugs that have improved efficacy.
I. Definition
Multiple myeloma is a malignant proliferative disease of plasma cells in which clonal plasma cells in the bone marrow proliferate abnormally and secrete monoclonal immunoglobulins or their fragments (M proteins) and cause associated organ or tissue damage (ROTI). Common clinical manifestations are bone pain, anemia, renal insufficiency, and infection.
II. Clinical manifestations
The most common symptoms of multiple myeloma are those associated with anemia, renal insufficiency, infection or bone destruction. Commonly, there are.
1. Skeletal symptoms: bone pain, local masses, pathological fractures, and may be combined with paraplegia.
2, decreased immunity: recurrent bacterial pneumonia and urinary tract infections, sepsis; viral infections with herpes zoster are common.
3, anemia: orthocytic orthochromic anemia; a few combined with leukopenia and thrombocytopenia.
4, hypercalcemia: vomiting, weakness, confusion, polyuria or constipation, etc.
5, renal impairment: light chain tubular nephropathy is the most common cause of renal failure.
6, hyperviscosity syndrome: there may be dizziness, vertigo, blurred vision, tinnitus, and sudden onset of impaired consciousness, finger numbness, insufficient coronary artery blood supply, and chronic heart failure. In addition, the M component of some patients is cold globulin, which causes microcirculatory disorders and Raynaud’s phenomenon.
7.Other: Those with amyloid lesions may show hypertrophy of tongue, enlarged parotid gland, enlarged heart, diarrhea or constipation, enlarged liver and spleen and peripheral neuropathy; advanced patients may also have bleeding tendency.
Diagnostic criteria
1. Main criteria.
(1) Tissue biopsy proves the presence of plasmacytoma or bone marrow smear examination: plasma cells > 30%, often accompanied by morphological changes.
(2) Monoclonal immunoglobulin (M protein): IgG>35g/L, IgA>20g/L, IgM>15g/L, IgD>2g/L, IgE>2g/L, monoclonal K or λ light chain in urine>1g/24 hours, and exclude amyloidosis.
2. Secondary criteria.
(1) bone marrow examination: plasma cells 10%-30%.
(2) The presence of monoclonal immunoglobulin or its fragments, but below the above criteria.
(3) X-ray examination with osteolytic damage and/or extensive osteoporosis.
(4) Decreased amount of normal immunoglobulin: IgM.