Anemic syndrome in the complex of clinical and haematological manifastations in multiple myeloma of Transcarpatia

Keywords: multiple myeloma; anemia; diagnosis; treatment; Transcarpathia region.


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.


Download data is not yet available.


Alexander, D. D., Mink, P. J., Adami, H. O., et al. (2007). Multiple myeloma: a review of the epidemiologic literature. International Journal of Cancer, 120(12), Suppl. 40–61.

Becker, N. (2011). Epidemiology of multiple myeloma. Recent Results Cancer Res., (183), 25–35.

Birgegard, G. (2008). Managing anaemia in lymphoma and multiple myeloma. Ther. Clin. Risk Manag., 4(2), 527–539.

Bouchnita, A., Eymard, N., Moyo, N. R., et al. (2016). Bone marrow infiltration by multiple myeloma causes anemia by reversible disruption of erythropoiesis. American Journal of Hematology, 91(4), 371–378.

Bray, F., Ferlay, J., Soerjomataram, I., et al. (2018). Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancer in 185 countries. CA: A Cancer Journal for Clinicians, (68), 394–424.

Dimopoulos, M. A., Moreau, P., Terpos, E., et al. (2021). Multiple mieloma: EHA-ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology, (32), 309–322.

Fedorenko, Z. P., Mikhailovich, Y. U., Gulak, L. O., et al. (2021). Cancer in Ukraine, 2019-2020. Morbidity, mortality, indicators of oncology service activity. Bul. Nat. Registry of Ukraine, (22), 82. [Ukrainian].

Ferlay, J., Colombet, M., Soerjomataram, I., et al. (2019). Estimating the global cancer incidince and mortality in 2018: GLOBOCAN sources and methods. International Journal of Cancer, (144), 1941–1953.

Greer, J. P., Arber, D. A., Glader, B., et al. (ed.) (2014). Wintrobe’s clinical hematology 13th ed., Philadelphia: Lippincott Williams & Wilkins. 2278 p.

Iskrov, I. A., Koshkevich, V. V., Lendina, I. Y., et al. (2021). Lecheniye pazientov s refrakternoj/rezidiviruyusthej mnozestvennoj mielomoj. Hematologija. Transfusiologija. Vostochnaja Evropa, 7(2), 242–252. [Russian].

Jaffe, E. S., Harris, N. L., Stein, H., & Vardiman, J. W. (2001) WHO classification of tumours: pathology and genetics of tumours of haematopoietic and lymphoid tissues. Lyon: IARC Press:352 p.

Laudin, G. E., Levay, P. F., & Coetzer, B. (2020). Globulin fraction and albumin: globulin ratio as a predictor of mortality in a South African multiple myeloma cohort. International Journal of Hematologic Oncology, (9), IJH27.

Martino, A., Sainz, J., Buda, G., et al. (2012). Genetics and molecular epidemiology of multiple myeloma: the rationale for the IMMEnSE consortium (review). International Journal of Oncology, 40(3), 625–638.

McKenna, R. W., Kyle, R. A., Kuehl, W. M., et al. (2008). Plasma cell neoplasms. in WHO Classification of Tumours of Haemapoetic and Lymphoid Tissues. Lyon: IARC:200-213.

Mittelman, M. (2003). The implications of anemia in multiple myeloma. Clinical Lymphoma, suppl., (1), 23–29.

Novak, V. L., Masljak, Z. V., Goryainova, N. V., et al. (2020). Pokaznyky dijal’nosti gematologichnoji sluzby Ukrajiny v 2019 rozi. Lviv, 52 p. [Ukrainian].

Palumbo, A., & Anderson, K. (2011). Multiple myeloma. New England Journal of Medicine, 364(11), 1046–1060.

Pydi, V. R., Bala, S. C., Kuruva, S. P., et al. (2021). Multiple myeloma in young adults: a single centre real world experience. Indian Journal of Hematology and Blood Transfusion, (37), 679-683.

Rajkumar, S., & Kumar, S. (2016). Multiple mieloma: diagnosis and treatment. Mayo Clinic Proceedings, 91(1), 101–119.

Rukavitsin, O. A. (ed.) (2015). Gematologija: nazional’noe rukovodstvo. Moskwa: Izdatel’skaja gruppa “GEOTAR-Media”, 2015. 776 p. [Russian].

Siegel, R. L., Miller, K. D., Fuchs, H. E., & Jemal, A. (2021). Cancer Statistics 2021. CA: A Cancer Journal for Clinicians, (71), 7–33.

Turner, J., Parsi, M., & Badireddy, M. (2020). Anemia. StarPearls [Internet].

Vydyborets, S., & Borysenko, D. (2019). Diagnostychna cinnist doslidzhennya transferynu na raznyh stadiyah rozvytku anemii zloyakisnogo novoutvorennya u pazientiv iz urutelialnym rakom sechovogo mihura. World Science (Poland), 12(52), 25–31. [Ukrainian].

Vydyborets, S., & Borysenko, D. (2019). Gepsydyn, transferyn, ferytyn: fiziologichna rol yak tsentralnyh regulatoriv obminu zaliza v organizmi. Science Review (Poland), 10(27), 8–15. [Ukrainian].

Vydyborets, S. V. (2022). Metabolizm zaliza i zalizodefizytni stany: monograph. Boston: Publisced by Primedia eLaunch. 264 p. [Ukrainian].

Wallin, A., & Larsson, S. C. (2011). Body mass index and risk of multiple myeloma: a meta-analysis of prospective studies. European Journal of Cancer, 47(11), 1606–1615.

Unified Clinical Protocol of Primary Secondary (Specialized) Medical Care. Multiple Myeloma. Ministry of Health of Ukraine. 2015. 45 p. [Ukrainian].

Weiss, B. M., Abadie, J., Verma, P., et al. (2009). A monoclonal gammopathy precedes multiple myeloma in most patients. Blood, 113(22), 5418–5422.

Wildes, T. M., & Anderson, K. C. (2021). Approach to the treatment of the older, unfit patient with myeloma from diagnosis to relapse: perspectives of a US. Hematology, American Society of Hematology Education Program, 7(2), 242–252.

Willrich, M. A., & Kartzman, J. A. (2016). Laboratory testing requirements for diagnosis and followOup of multiple myeloma and renal plasma cell dyscrasias. Clinical Chemistry and Laboratory Medicine, 54(6), 907–919.

Yildirim-Kahriman S. (2021). Non-intrinsic cancer risk factors. Experimental oncology, 43(4), 290–297.

Abstract views: 12
PDF Downloads: 11
How to Cite
PopovychМ. Y. (2022). Anemic syndrome in the complex of clinical and haematological manifastations in multiple myeloma of Transcarpatia. Likars’ka Sprava, (5-6), 39–52.