Anemic syndrome in the complex of clinical and haematological manifastations in multiple myeloma of Transcarpatia
Multiple myeloma (MM) is the most common type of paraproteinemic hemoblasosis, which is characterized by an aggressive course, high mortality and a large number of complications. The analysis of Multiple Myeloma (MM) incidence in the Amur Region for the period from 2015 to 2020 has been made. MM takes the fourth place in the general structure of leukemia. Average annual morbidity of MM is 1,24–1,4 per 100 000 people. The number of cases of MM is constantly increasing lately. The mean age of patients is 57 (± 5,8). It is more predominant in men then in women. The introduction of immunomodulatory drugs, monoclonal antibodies, and proteasome inhibitors into the therapy of MM significantly increased the median of overall survival over the past 20 years from 3–4 to 7–8 years. Almost all patients with MM relapse in different intervals. The duration of remission after relapses decreases with each cycle. The personalized choice of tactics for treatment of recurrent and refractory MM is of particular interest. This takes into account many factors: previous therapy (introduction mode, number of therapy lines), aggressiveness of relapse, patient’s condition, ect. The purpose of the review: to investigate the main biochemical parameters that characterize protein and iron metabolism, the activity of key enzymes in patients with multiple myeloma, the course of their underlying disease was aggravated by anemia at different stages of the disease for further prospects of optimizing diagnosis, predicting the course of the disease in clinical practice. Materials and methods. A analysis of the data of 41 patients with MM complicated by 37 anemia was conducted. The severity of anemia was defined according to the criteria proposed by the National Cancer Institute (USA) as follows: mild-hemoglobin (Hb) from 10 to 12 g/dL, moderate - Hb from 8 to 10 g/dL; severe - Hb from 6,5 g/dL to 8 g/dl, life-threatening - Hb below 6,5 g/dL. According to the hemoglobin level, the patients were divided into 4 groups: the first group included 16 patients with mild anemia, hemoglobin level above 101–120 g/l; the second group consisted of 8 patients with moderate anemia, with hemoglobin level from 80 to 100 g/l; the third group included 7 patients with severe anemia, hemoglobin level – 65–79 g/l; the four group consisted of 6 patients with life-threatening anemia, hemoglobin level – below 65 g/l. All patients were examined after verifying the diagnosis and before starting any treatment. Statistical processing of the obtained data was conducted using the methods of variation statistics using a computer program Microsoft Excel XP. Results. The course of ММ, in which the proliferation of a malignant clone is accompanied by the secretion of paraproteins, is often complicated by anemia (90,2 %). To evaluate the possible diagnostic and prognostic value of the studied indicator. Different types of MM were analyzed. During retrospective research of life expectancy of patients with MM. The adverse factors of MM were revealied. The article discusses possible pathophysiological mechanisms of the identified changes. Conclusion. The results of the study show that with progression of the disease, increase of tumor mass in MM patients with secretion of paraproteins, there is the tendency towards a more severe degree anemia. The leading cause of anemia in these patients is the infiltration of the bone marrow by tumor cells.
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