“The following is a summary of the questions frequently asked by patients and their families, and represents only my personal view.
I. About the diagnosis of multiple myeloma For the diagnosis of multiple myeloma, there is only an expert consensus, which is not yet standardized, including domestic guidelines and international guidelines, and many places need to be improved. For the diagnosis of clinical cases, some are very difficult. However, it must be noted that.
1. Clinical symptoms associated with multiple myeloma: bone pain and pathological fractures, anemia with coiled money-like arrangement of red blood cells, impaired renal function, recurrent infections, hypercalcemia, and abnormalities in the blood clotting mechanism. In addition, serum free light chain is also important, especially for patients with asymptomatic myeloma, if the free light chain ratio is more than 100, it is also very likely to progress in the short term. Yang Guangzhong, Department of Hematology, Beijing Chaoyang Hospital
2, monoclonal plasma cells: express CD38 and CD138, while expressing light chain kappa or lambda (only one of them), can express CD56, CD20, CD28, CD117 at the same time.
3, Plasma cells in the bone marrow must be primitive or naive plasma cells, not reactive plasma cells (i.e. mature polyclonal plasma cells).
4, M protein: unless oligosecreting or nonsecreting patients, there must be monoclonal proteins, while the majority of background proteins are below normal. For example, IgG type MM, its IgG will be abnormally high, while IgA and IgM are generally lower than normal; if it is light chain type, then IgG IgA IgM are generally lower than normal. Serum free light chain is very important for the diagnosis of non-secretory and oligosecretory patients.
5.Other reference indicators: increased erythrocyte sedimentation rate, elevated blood calcium, abnormal coagulation mechanism, elevated blood and urine beta2 microglobulin, multiple skeletal osteolytic destruction.
6. Pay attention to differentiation from other diseases. After all, myeloma is not a common disease, not as common as solid tumors.
II. Differential diagnosis of multiple myeloma
Multiple myeloma is not a common disease and can often be encountered as a misdiagnosed case. It is recommended to visit the hematology department to exclude myeloma if the following conditions exist
1. Infection misdiagnosed as respiratory disease
For middle-aged and elderly patients with recurrent infections, they should not be limited to anti-infection treatment only, but should actively look for any primary diseases along with anti-infection treatment. If the patient has combined bone pain, anemia, bleeding, etc. the possibility of this disease should be considered.
2.Myeloma bone disease – orthopedics
Bone pain and osteolytic bone destruction are the prominent clinical manifestations of this disease. Bone pain sites are most common in the lower back, followed by the sternum, ribs and lower limb bones. In middle-aged and elderly patients with severe osteoporosis or fractures, this disease should be considered in the diagnosis. Pay attention to check blood immunoglobulin and serum protein electrophoresis, etc. for early and clear diagnosis.
3, myeloma nephropathy – nephrology, Chinese medicine
Renal disease becomes a common and important lesion in this disease. For middle-aged and elderly patients who cannot be clearly diagnosed with long-term proteinuria and hematuria, renal biopsy, bone marrow aspiration or myeloma-related tests such as bone marrow, blood immunoglobulin and serum protein electrophoresis should be performed promptly.
In addition, the following conditions are easily confused with myeloma.
1, reactive plasmacytosis: seen in tuberculosis, typhoid fever, autoimmune diseases, etc. Generally, bone marrow plasma cells do not exceed 10%; and all are mature plasma cells. Immunoglobulins are normal polyclonal with limited elevated levels (e.g., IgG <;30 g/L). Clinical manifestations depend on the primary disease, there are no MM-related clinical manifestations of the primary disease.
2. monoclonal immunoglobulinemia of undetermined significance (MGUS): serum M protein IgG <;30g/L, IgA <;20g/L, plasma cells in bone marrow less than 10%;, without osteolytic lesions, anemia, hypercalcemia and renal insufficiency. m protein may remain unchanged for many years and normal immunoglobulins are not reduced. About 5%; of patients eventually develop multiple myeloma.
3. Other diseases that produce M protein: chronic infections, chronic liver diseases, autoimmune diseases, malignant hematological diseases (such as lymphoma), non-malignant hematological diseases, non-hematological malignancies, neurological diseases, skin diseases, organ transplants, etc. may produce small amounts of M protein, presumably due to abnormal immune responses of the patient’s organism to antigens. This monoclonal immunoglobulin increase is limited, usually IgG <;30g/L, IgA <;20g/L, IgM <;10g/L . It does not cause any clinical symptoms per se, and its clinical manifestations depend entirely on the primary disease. No myeloma cells on bone marrow aspiration and no osteolytic lesions on X-ray examination.
4, other causes of nephropathy: renal damage is one of the important clinical manifestations of MM. MM patients are easily confused with “chronic glomerulonephritis” and “nephrotic syndrome”. It is not difficult to distinguish renal disease from MM, but the key is to think of the possibility of MM. In elderly patients with renal damage and skeletal pain or anemia that does not parallel renal insufficiency (renal anemia parallels the degree of renal insufficiency), it is recommended to perform the relevant MM examination.
5, primary systemic amyloidosis: belongs to the same category of malignant plasma cells as MM, MM can be secondary or concomitant systemic amyloidosis, and the two have similarities in clinical manifestations, while the treatment and prognosis are different. The clinical manifestations are caused by the deposition of amyloid (i.e., light chains of immunoglobulins) in tissues and organs. Laboratory tests may (but not always) reveal monoclonal immunoglobulin light chains in the serum and/or urine, positive urine native-weekly protein, hypoalbuminemia, and renal insufficiency (elevated blood urea nitrogen and creatinine). No myeloma cell infiltration in bone marrow, no osteolytic lesions in bone, no hypercalcemia, hyperviscosity syndrome.
6. Primary macroglobulinemia: mainly distinguished from IgM-type myeloma. Macroglobulinemia is characterized by ① monoclonal increase of IgM type immunoglobulin in blood, while other immunoglobulins are normal or mildly suppressed. ②Imaging: osteoporosis is less commonly seen on X-ray radiographs, and osteolytic lesions are extremely rare. ③Plasma cell morphology: lymphocytes and plasma cell-like lymphocytes are prevalent in the bone marrow. Biopsies of lymph nodes, liver and spleen suggest diffuse well-differentiated or plasma-like lymphocytic lymphoma. ④Immunophenotype: mostly IgM+, IgD-, CD19+, CD20+, CD22+, CD5-, CD10- and CD23-.
7, . Low back pain disease: Low back pain is one of the main symptoms of multiple myeloma, and is often one of the complaints of patients seeking medical attention, who may choose general surgery and orthopedics to consult. Multiple myeloma is often misdiagnosed as “lumbar strain”, “disc herniation”, “lumbar tuberculosis”, “osteoporosis “osteoporosis” and other diseases. When elderly patients present with complaints of lumbar pain, especially when the lumbar pain is persistent and worsens after activity, with localized pressure pain, accompanied by anemia or significantly increased blood sedimentation, even though no osteolytic lesions or compression fractures are seen on X-ray, relevant tests (bone marrow aspiration, protein electrophoresis, immunoelectrophoresis, etc.) should be performed to exclude or confirm the diagnosis of multiple myeloma.
8. Bone metastases: malignant tumors are prone to bone metastases, causing bone pain, osteolytic lesions, anemia and other clinical manifestations, which are similar to multiple myeloma and need to be differentiated. Generally, there is no M-component in the blood, so that occasionally monoclonal immunoglobulin increase, its increase level is also limited. Bone marrow aspiration or biopsy reveals piles of metastatic cancer cells, which are significantly different from myeloma cells in morphology and distribution. They have the clinical manifestations of their primary tumor. There is increased bone density around the osteolytic defect and a significant increase in serum alkaline phosphatase. There is a primary lesion present.
9. Other diseases that invade the bone and need to be differentiated from MM: ①Lymphoma can invade the bone and form skeletal masses: no myeloma cells in the bone marrow; no extensive osteoporosis and multiple osteolytic lesions; pathological biopsy is required to confirm the diagnosis. ② hyperparathyroidism: bone changes characterized by extensive decalcification, fibrocystic osteitis and bone cyst formation; no monoclonal immunoglobulin or its light chain in blood and urine, no myeloma cells in bone marrow.
The above is for the reference of those patients who have not yet been diagnosed or who need further clarification.
With the increase of media reports and internet communication, it seems that people are now taking myeloma seriously.
I recently encountered an elderly patient in my outpatient clinic with severe bone pain and the presence of bone destruction on imaging. Myeloma was immediately suspected in the local hospital and the patient was referred to our hospital. I also thought of myeloma and did the relevant tests; however, at the same time I was alert to the presence of metastatic cancer. So, I screened for tumor markers. The results confirmed: this patient was a bone metastasis of cancer, not myeloma.
My purpose here is to tell those who have not yet been diagnosed: myeloma is a relatively rare tumor, accounting for only 1%; of all malignant neoplastic diseases and 10%; of malignant blood disorders. So, be sure to identify other related diseases! For example, elderly patients with bone pain should always be screened for tumor markers. When multiple myeloma is highly suspected, it should be screened by timely correction by hematology department.
III. About the causes of multiple myeloma
Many patients and family members often ask me what is the cause of multiple myeloma. The real pathogenesis of the disease is not clear, and it may be related to gene mutation, which is still unclear.
IV. About the bone disease of multiple myeloma
Patients with myeloma have heavy bone destruction, so it is usually appropriate to sleep on a flat bed, which should not be padded too much, so as to help the spine maintain a normal position. For those who cannot get out of bed temporarily, they should also strengthen functional exercise, use foot stirrups, flex and extend the lower limbs; if they cannot move by themselves, they need family members’ assistance and should not be left alone, but they should pay attention to moderation and should not exert too much force. If you can get out of bed, don’t stay in bed for a long time. Long-term bed rest can lead to aggravation of osteoporosis and muscle atrophy; don’t be afraid of mild pain; it is better to listen to the advice of hematologists, not to be treated as ordinary orthopedic patients, almost all MM patients have mild or severe bone problems. As far as I know, orthopedic surgeons are afraid to let MM patients move early, especially those with pathological fractures; in fact, under certain protective measures, moderate exercise is beneficial to the treatment of the disease.
As for going to professional institutions for rehabilitation exercises, I personally have reservations. Because patients with myeloma are different from patients with cerebrovascular diseases, their bones are severely damaged, and if they are overstretched, it is bound to backfire.
MM can lead to osteoporosis, bone destruction and pathological fracture.
Aggressive treatment of bone disease can significantly improve the patient’s quality of life and reduce the likelihood of skeletal accidents. A variety of bisphosphonates are clinically available for application.
However, “it’s a drug with three toxins”, be highly alert to the side effects of bisphosphonates, commonly renal injury and osteonecrosis of the jaw, mostly seen in patients with prolonged application of bisphosphonates (more than 2 years), generally unless patients with severe bone disease, usually once every four weeks is sufficient, and repeated after two weeks if necessary in severe cases. Patients approaching or more than 2 years should be cautious in the use of the drug, unless MM recurrence progresses, it is generally recommended to discontinue the application, if necessary, once every 3 months.
The application of bisphosphonates can be reduced if the bone destruction is not severe and is only limited, while no hypercalcemia is present. However, in recent years, it has been suggested that the application of bisphosphonates in patients with myeloma is beneficial even in the absence of bone destruction. However, the effective application of bisphosphonates presupposes active treatment of MM, and if the primary disease is poorly treated, then bisphosphonates have little effect; to put it bluntly, bisphosphonates belong to adjuvant therapy.
Should primary myeloma patients with pathological fractures undergo orthopedic surgery or chemotherapy first? This is a difficult question to answer, but it does exist in clinical practice. If the fracture has a significant impact on the patient, such as severe neurological compression, surgery is the first treatment; if the tumor load is large and serious complications, such as acute renal failure, are expected to occur soon, chemotherapy is recommended first. Regardless of the choice, patients have to face certain risks, and it must be stated that there is no foolproof solution. Patients with myeloma have severe destruction of bone lesions, which has been described as “glass man”, but this is not a contraindication to surgery, on the contrary, if there is an absolute indication for orthopedic surgery, surgery is still needed.
V. The problem of anemia in multiple myeloma
Anemia seriously affects the quality of life of patients. Today, the pursuit of the best quality of life has become one of the aims of our treatment. For patients with severe anemia, in addition to treating the primary myeloma, component blood transfusion is an option if necessary. However, for various reasons, blood transfusion is now extremely difficult. In this case, erythropoietin (EPO) therapy can be considered.
The specific usage is: 8,000-12,000 units per injection, subcutaneously, three times a week.
It usually takes effect in about 4 weeks, and if it is still not effective at 8 weeks, it will be discontinued.
The current health insurance policy states that only renal anemia and myelodysplastic syndrome anemia are reimbursable. Therefore, only patients with combined renal insufficiency among our patients can also be used at public expense.
VI. Questions about multiple myeloma infections
Infection is a common problem for myeloma patients due to the following reasons: 1 myeloma patients are old and mostly combined with other underlying diseases; 2 myeloma itself is a malignant blood disease that leads to immune deficiency; 3 repeated multiple chemotherapy. Not only that, infection is also one of the most urgent problems for myeloma patients to control, because the process of infection can lead to a large release of interleukin 6, a cytokine that can promote the growth of myeloma cells and affect the normal treatment of the disease; once infection occurs, it must be given high priority and treated by a doctor in a timely manner. However, given the 3 reasons mentioned above, infections in myeloma patients are also difficult to treat and may take a longer time to treat.
In a word, infections in myeloma are common, more difficult to treat, and must be obtained promptly. Therefore, it is extremely important to prevent infections well.
It has been mentioned several times above that patients with myeloma are older, have a lower immune system and are prone to infections. Here, fungal infections are singled out in the hope of gaining your attention.
Fungi are everywhere around us. When immunity is normal, they can coexist peacefully with us, so fungal infections rarely occur in normal healthy people; once immunity is low, fungi can lead to serious infections, the most common ones are skin fungal infections, oral fungal infections, and less common ones are digestive tract and lower respiratory tract. The most serious one is fungal infection in the lung, which generally manifests as fever, coughing sputum (sputum is mostly white, if combined with bacterial infection, it can be yellow, sputum is sticky, not easy to cough up, and is in the form of lassitude, if the sputum is easily coughed up, it is mostly not fungal), chest tightness, breath-holding, etc. Some patients can have blood in sputum or even hemoptysis. In addition, fungal infections tend to occur together with bacterial infections, that is, mixed infections. Relatively speaking, bacterial infections are slightly better controlled than fungal infections, while fungal infections are difficult to obtain a complete cure. Therefore, once a fungal infection in the lung is diagnosed, a longer course of antifungal treatment is required, which will inevitably affect the treatment for the primary disease. In addition, antifungal drugs are very expensive, and some effective drugs are not reimbursed by medical insurance.
From the above, it is important to pay attention to and be alert to fungal infections, which is a major issue in the treatment of myeloma patients and should not be taken lightly.
How to prevent fungal infections? The easiest way is to pay attention to hygiene, especially oral hygiene. You can apply saline gargle containing sodium bicarbonate (configuration: 20 tablets of sodium bicarbonate, i.e. 10 grams, dissolved in 0.9%; saline 500ml) and gargle several times a day. This is because our mouth contains more conditionally pathogenic bacteria, and fungi are harder to survive in an alkaline environment.
Continuing the topic of infections above
1. Viral infections such as herpes zoster, mostly seen in patients treated with Vanco. Herpes zoster, commonly known as “tangled dragon”, usually occurs along the nerve alignment, commonly in the intercostal nerve, the herpes zoster virus often attacks the nerve, leading to related problems, such as pain, itching. It is not easily cured, and many patients have varying degrees of sequelae (such as the symptoms described above) that affect their daily lives. How to prevent it? Try taking acyclovir or famciclovir during treatment of myeloma. Other viral infections, such as influenza virus and cytomegalovirus, are also very common.
2. Tuberculosis infection Our patients with myeloma may not show typical signs of tuberculosis, otherwise there would be no need to single them out and talk about them. It can be said that the clinical manifestations of tuberculosis infection are highly variable and can involve almost all major systems of the body. Clinical manifestations can be fever of unknown origin (more than 2 weeks, conventional treatment is ineffective), not necessarily low fever in the afternoon, not necessarily the presence of other symptoms such as night sweats, not necessarily cough and sputum. This makes it difficult for us to diagnose and treat clinically. Clinically, we must be alert to TB infection when we encounter fever of unknown origin; if TB infection is highly suspected, experimental anti-TB treatment is permissible. The purpose of this point is that it is not always possible to find sufficient evidence of tuberculosis infection when there is a high suspicion of tuberculosis, but at this time it is important to promptly treat with experimental anti-tuberculosis therapy and not to “miss the opportunity”! The effectiveness of experimental anti-tuberculosis treatment (usually 3-4 weeks) is also strong evidence for the diagnosis of tuberculosis infection; if the fever does not subside after 4 weeks of treatment, the drug should be stopped decisively and other causes should be explored. This requires the understanding and active cooperation of our patients and their families.
VII. On the issue of multiple myeloma nephropathy
Myeloma can be secondary to kidney damage and even manifest as uremia. For this part of patients, thalidomide, high-dose dexamethasone and Vanco are effective, but the efficiency is only 40-70%; it varies, and it must be treated early and timely, once the time exceeds 2 months, the treatment is more difficult. In addition, if combined with nephrotic syndrome (clinical manifestations of massive proteinuria, hypoproteinemia, swelling, with or without renal insufficiency), treatment is very difficult. This is also one of the difficulties in clinical practice. For patients with combined renal insufficiency, a treatment regimen containing high doses of dexamethasone is recommended. In a significant number of patients, renal insufficiency can be reversed by treatment.
Do I need to restrict water intake in patients with multiple myeloma combined with renal insufficiency? Roughly 20-40% of patients with MM may develop renal insufficiency. These patients do not need to restrict water intake, but should instead consume enough water to ensure a daily urine output of more than 2000 ml to facilitate recovery of renal function, especially in the early stages of the disease. Excreting at least 2000ml of urine daily can promote the excretion of light chains, reduce the possibility of precipitation in the kidneys and mitigate its adverse effects on the kidneys. If necessary, sodium bicarbonate can be taken to alkalinize the urine and note the uric acid level, if it is higher than normal, it is recommended to add allopurinol.
Here, I would like to highlight the following tips.
1. Patients with combined nephropathy have a poor prognosis; once diagnosed, the primary disease should be actively treated and the regimen containing the new drug should be preferred; according to reports from several centers at home and abroad, the treatment regimen containing Vanco is still preferred; we found that the Vanco-based combination regimen can rapidly reduce myeloma load, reverse renal function, and improve the prognosis of patients. In comparison, the efficacy of the regimen without Vanco is slightly inferior, but if economic conditions do not allow, it is recommended to choose the regimen containing thalidomide and high-dose dexamethasone.
2.If the urine volume is still normal, regardless of the creatinine level, you should actively drink water to ensure that the daily urine volume is at least 2000ml, which is conducive to the discharge of light chains from the kidneys; it can be said that the light chains in the body are the culprit of myeloma nephropathy, and a large amount of light chains are deposited in the renal tubules to form light chains tubular, which block the renal tubules and lead to acute renal failure, which is one of the main mechanisms of its development.
3, reduce the intake of soy foods and acidic foods, these are not conducive to the recovery of kidney disease.
4.In case of significantly elevated serum creatinine, it should receive dialysis treatment.
5.. Cooperate well with the treatment by the competent physician, do not hesitate and do not miss the best time for treatment. Clinically, it is found that patients with renal insufficiency within 2 months of onset have hope to recover their renal function; statistics found that through timely treatment, about 60-70%; of patients can obtain different degrees of improvement in renal function.
VIII. On the issue of secondary extramedullary plasmacytoma
Combined extramedullary plasmacytoma is also one of the difficult problems in clinical treatment, and the prognosis of this group of patients is relatively poor. Generally, chemotherapy is sensitive to intramedullary lesions, but the effect of extramedullary lesions is much worse, and even if it is effective, it is difficult to maintain the efficacy for a long time, which may be the root cause of disease recurrence later. Therefore, early treatment should focus on extramedullary issues. We recommend in most cases that systemic chemotherapy is needed for multiple extramedullary plasmacytomas. On the basis of chemotherapy, those who are suitable for surgery (single extramedullary lesions or those with compression symptoms) can be surgically excised followed by local radiotherapy; those who are not suitable for surgical excision should undergo local radiotherapy if necessary, which requires a clinical decision by the physician in charge.
IX. About secondary amyloidosis
Multiple myeloma is prone to secondary amyloidosis, which can involve almost every organ system in the body (skin, heart, lung, liver, kidney, digestive system, etc.), and is extremely difficult to treat. In such cases, it is important to actively treat the primary disease. Only with effective treatment of myeloma is it possible to control the progressive deterioration of amyloidosis.
Skin manifestations include skin petechiae, “panda eyes”, and subcutaneous bruising changes of unknown origin.
Renal manifestations include nephrotic syndrome (massive proteinuria, hypoproteinemia, swelling) and renal insufficiency.
Heart manifests as heart failure and asymmetric thickening of the cardiac septum.
Liver manifests as hepatomegaly, elevated transaminases, elevated bilirubin, and pain in the liver area.
The lung manifested as cough, coughing sputum, blood in sputum, and dyspnea.
The digestive system manifests as hypertrophy of the tongue, slurred speech, gastrointestinal bleeding (black stool), etc.
The above manifestations are not specific and must be considered comprehensively. Clinical hematologists should be asked to screen them for early detection of the disease.
X. Can myeloma affect the heart?
Yes!
The reasons are as follows.
First, mainly myeloma can lead to anemia; second, it can cause secondary amyloidosis; third, some drugs in chemotherapy may also affect the heart, which is inevitable, such as thalidomide, ranadomide, Vanco, dexamethasone and drugs like Adriamycin; fourth, the average age of myeloma patients is older, and myeloma-related cardiac events may be more likely to occur if the patient has pre-existing hypertension, diabetes, coronary heart disease, etc. Fifth, cardiac events can also be triggered by previous lung disease, such as chronic bronchitis, emphysema, tuberculosis, bronchiectasis, asthma, or severe pneumonia.
In contrast, cardiac events are less common in patients with myeloma than in those with anemia, bone pain, infection, or impaired renal function; however, because of the specific nature of cardiac events, we should still not take them lightly.
The following points can be referred to.
1. checking myocardial related indexes such as troponin, creatine kinase isoenzyme, BNP, etc. before each chemotherapy, as well as the necessary electrocardiogram, especially in elderly patients.
2. It is recommended to check cardiac ultrasound every six months and at any time when the condition changes.
3.If you have underlying diseases such as hypertension, diabetes, heart disease, etc., be sure to communicate with your supervising physician in a timely manner.
4.Low salt and low fat diet, more green vegetables, not “big supplements”! Because hyperlipidemia is an independent risk factor for cardiac events, the resulting cardiac events are far more common than myeloma.
Will myeloma itself cause fever?
Yes.
However, it is extremely rare.
When myeloma disease itself is suspected of causing fever, all other causes of fever must be ruled out, including infection (bacterial fungal tuberculosis viral parasites), central lesions, autoimmune disease, and the presence of other tumors in combination.
It is recommended that myeloma patients with prolonged unexplained fever should check the ki67 positive rate of bone marrow plasma cells. If the ki67 positive rate is high (generally rarely more than 40%;), more than 50%; or even higher, the possibility of fever due to the primary disease should be highly alerted.
XII. About the treatment of myeloma
The key to the treatment of multiple myeloma is chemotherapy, and others such as the application of bisphosphonates for bone disease, correction of anemia, reversal of renal function, improvement of coagulation mechanism, and anti-infection, the key of which is to reduce the tumor load through chemotherapy, thus improving the immunity of patients, lifting the inhibition of plasma cells for normal hematopoietic function, and cutting off the bone destruction pathway. Clinically, too, if the disease is not well controlled, bone pain persists with the application of bisphosphonates, anemia continues to worsen, renal function cannot be reversed, infection is difficult to obtain effective control, and abnormalities of the bleeding and coagulation mechanisms cannot be improved.
Therefore, the key to the treatment of myeloma is timely and effective chemotherapy. Aggressive treatment of other comorbidities such as bone disease along with chemotherapy can improve the quality of life of patients and obtain a good quality of life.
Chemotherapy is indeed a double-edged sword, and its therapeutic effects are accompanied by potential and unpredictable toxic side effects. Some families of newly diagnosed patients are afraid to make the decision of whether to receive chemotherapy after being informed of their condition. Because of the potential toxic side effects of chemotherapy, especially in our older myeloma patients, many of whom are combined with other underlying diseases such as hypertension, diabetes, and heart disease, families are prone to hesitation. This is understandable.
It should be said that the pros and cons of whether to receive chemotherapy should be weighed. When the supervising physician gives you an explanation about chemotherapy, it is definitely because the supervising physician has already assessed the condition and believes that the advantages of chemotherapy outweigh the disadvantages for the patient, otherwise, the supervising physician would not have recommended chemotherapy. As long as the advantages outweigh the disadvantages, you should receive chemotherapy. Although chemotherapy has certain risks, the physician in charge will avoid and monitor them as much as possible during chemotherapy.
The treatment of multiple myeloma should be individualized and not one-size-fits-all. A comprehensive assessment of the patient’s condition should be made and a treatment plan should be developed.
Currently, there are many treatment options for multiple myeloma, among which Vanco-based regimen has the best efficacy, generally 2 courses of treatment can be effective, 4-6 courses of treatment to achieve the best efficacy, can rapidly reduce the patient’s tumor load, to obtain better results, the general efficiency of initial treatment patients up to 80%; relapse and then treatment patients efficiency up to 60%; which is not achieved by other traditional programs, the above results have been These results have been confirmed by a number of large-scale clinical data at home and abroad, and have pushed it to the first-line treatment of this disease.
The treatment of myeloma is a long-lasting battle. It is recommended that patients and their families should choose their treatment options according to their ability. In addition, the treatment of multiple myeloma advocates individualization rather than uniformity, and needs to be formulated with multiple parameters such as the patient’s age, heart, lung, liver and kidney function, disease stage, and the patient’s general condition. Furthermore, even if VANCOUVER is used, it is not 100% effective and there are many adverse effects of VANCOUVER.
Of course, for high-risk patients, a regimen containing mainly new drugs is still advocated, while other regimens are less effective. The so-called high-risk refers to those with abnormal genetic alterations such as p53, t(4; 14), t(14; 16), those with extramedullary lesions, those with multiple occurrences of plasma cells in p