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Anemia, kidney failure and bone pain: symptoms of multiple myeloma

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EVERY year it affects 5,800 people in Italy, especially the elderly. We are talking about multiple myeloma, the numbers of which are constantly increasing. A fact that, in reality, is positive, because it means that it is possible to live longer and longer with this pathology. We asked Alessandro Corso, Director of the Hematology UOC Complex Structure of the Legnano Hospital, ASST Ovest Milan, to explain to us what the symptoms of the disease are and how it is treated today.

Prof. Corso, what is multiple myeloma and what does it involve?
“It is a blood cancer typical of the elderly, usually diagnosed around 70 years of age. Much of the problems related to the disease are due to the production of abnormal proteins by cancer cells present in the bone marrow. When these proteins are present in large quantities, they lead to kidney failure. In the bone marrow they cause disorders related to immunosuppression, such as greater ease of contracting infections, or a reduction in red blood cells which can lead to anemia. Another characteristic consequence is skeletal weakening, which can be very serious ”.

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What are the symptoms?
“Some patients have no symptoms and discover they have this disease through routine tests. Others begin to suffer from kidney failure, develop anemia, have severe bone pain or even break very easily. The most frequent symptom is precisely this: 50% of patients discover that they have multiple myeloma due to bone lesions that can also lead to vertebral collapse or fractures of the long bones “.

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What therapies are used today?
“The scenario has changed a lot in the last 20 years: in the past the only approach was chemotherapy, while the younger ones, under 65, were advised to have autologous stem cell transplantation. Since the 2000s, biological drugs have been introduced, which interfere in different ways with the disease and act on the plasma cell and the medullary microenvironment. These medicines belong to three different families: immunomodulators, which include thalidomide, lenalidomide and pomalidomide; proteasome inhibitors, such as bortezomib, carfilzomib and ixazomib; monoclonal antibodies, i.e. elotuzumab, daratumumab and isatuximab. All these drugs, whose efficacy was initially verified as single agents, over time have been included in combination schemes as, thanks to their synergy, the efficacy against the disease is increased. Monoclonal antibodies, the latest arrivals, are no exception and are now part of myeloma therapy in all patient settings, young and old, in the various lines of therapy. Treatment protocols include a combination of at least two drugs and cortisone.

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What does ongoing therapy involve?
“Younger patients undergo a high-dose therapy program that involves several stages. The first phase is called ‘induction’, in which a combination scheme of the new drugs is used. At this point, the stem cells are collected and must be cryopreserved. This is followed by a high-dose chemotherapy, called “conditioning”, after which the stem cells are reinfused (autologous transplant, ed.), And continues with the ‘maintenance’ therapy “.

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How is the therapy administered?
“It depends on the type of drug. Immunomodulators are taken orally and require reduced checks once a month, in the clinic. Monocolonal antibodies are administered intravenously. An exception is daratumumab, which in 2022 we should be able to inject subcutaneously, a much faster modality. Proteasome inhibitors, on the other hand, also differ from each other by their intake: bortezomib is injected subcutaneously, carfilzomib in a vein and ixazomib is taken orally “.

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What is the quality of life of the patients?
“Continuous therapy, which includes an attack phase and then a maintenance phase, guarantees an important advantage for the control of the disease, which one can live with for many years. Patients’ quality of life is influenced by both the methods of administering drugs and their tolerability. Taking oral therapies and decreasing the number of visits is very important. We try to eliminate side effects as much as possible with changes in the schemes and reductions in the doses of medicines, which in any case are usually well tolerated even by the elderly ”.

What causes multiple myeloma?
“Today we don’t know what triggers multiple myeloma. Numerous studies have been carried out to demonstrate possible correlations with exposure to radiation and chemicals, but nothing conclusive has ever been shown. Genetic errors overlap which make the onset of the disease unpredictable. It is not hereditary, but a familiarity can be observed, a kind of predisposition to develop it: an immune system that works with difficulty seems to be able to contribute, although there is still no scientific evidence. All the genetic alterations that we encounter, however, are not transmissible, but acquired over the course of life “.

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