Multiple myeloma is a plasma cells cancer, usually formulating from bone marrow, the blood generating tissue that fills up the bone spaces. Myeloma builds up when an ordinary plasma cell is converted into a malignant body cell and starts to grow up uncontrollably.
As myeloma cells begin to divide and increase in size and number, its affect the patient in many ways. Those cells hamper with the body's capability to create bone and as an alternative cause bones to break down and weaken. Spine, ribs, skull and pelvic bones are generally involved. Those damaged bones are prone and threaten to fractures even with small stresses. As bones break down, calcium is released into the blood flow and may initiate a situation called hypercalcaemia which associated with pain, vomiting, nausea, depression and altered mental states etc.
The propagation of myeloma cells within the bone marrow will decrease the generation of healthy blood cells. The patients become anaemic and in more severe condition will have white cell counts (leucopenia) and low platelet (thrombocytopenia).
Myeloma cells generally produce an abnormal protein (an M protein or monoclonal) that can cause harm to the body organs especially kidneys. High levels of myeloma proteins and calcium can interfere with kidney functions and reduce its ability to filter blood appropriately. This will consistently lead to permanent kidney failure and/or damage.
Usually, myeloma is a progressive illness associated with severe anaemia, bruising and bleeding, tiredness, painful fractures and bone weakness and damage to the different organs such as the kidneys. The disease is consistently fatal without any treatment and means survival period is 18 months or less.
In the past, mean survival period of about two or three years was gained with usual chemotherapy. The Upfront therapy with new generation of the targeted therapies (thalidomide, bortezomib and lenalidomide) has shown significant developments in the response rates. Nevertheless, none of those new treatments have been experimented in prospective randomized tests in patients who are the candidates of transplant. Autologous transplant continues to be Standard Care for all diagnosed myeloma patients recently who are deemed fit to go through the transplant. Mean survival period beyond five years has usually been reported after the autologous stem cell transplant for the multiple myeloma patients.
Allogeneic hematopoietic cell transplantation
Allogeneic HCT or hematopoietic cell transplantation may be only treatment for the patients of multiple myeloma that has a possibility of producing cure. However, its use is limited since even perfect candidates who go through the allogeneic HCT have a large number of treatment-related deaths, and because its effectiveness compared with the autologous HCT is not completely established. The treatment-related deaths associated with the allogeneic HCT are diminishing with the introduction of nonmyeloablative preparative regimens. New chemotherapeutic agents (e.g., thalidomide, lenalidomide, bortezomib) are being included into the preliminary treatment of multiple myeloma at the same time, and survival with chemotherapy only or with the autologous HCT is developing. As such, the function of the allogeneic HCT in the multiple myeloma treatment is not clear.
Autologous hematopoietic cell transplantation
Autologous HCT or hematopoietic cell transplantation carried out either at relapse or at the time of primary diagnosis is considered the standard care for younger patients (age less than 70 years) with newly recognized multiple myeloma. While neither autologous HCT nor chemotherapy produces a cure, overall survival and event-free survival are extended following autologous hematopoietic cell transplantation when evaluated with treatment with usual chemotherapy only.
As new chemotherapeutic agents (e.g. thalidomide, lenalidomide, bortezomib) are incorporated into the preliminary treatment of multiple myeloma, living with chemotherapy only is improving. If the use of those newer agents, in combination or alone, will eliminate or delay the requirement for hematopoietic cell transplantation in patients with the multiple myeloma is not familiar at this time. Additionally, survival with the HCT is developing for certain populations through the incorporation of double autologous HCT.
In contrast, the allogeneic HCT has the possibility for cure, even though at a charge of increased treatment-related death. The applications of allogeneic HCT for the multiple myeloma are increasing.
Advantages of Stem Cell Transplantation
Stem cell transplantation means the transfuse stem cells like medication into the patient's body and those will restore the damaged organs and tissue cells in order to manage diseases. This treatment does not change function and structure of the original organs and tissues, but it can recognize the unpredicted effects that other treatment method cannot achieve. It will not cause the immunological rejection. It doesn't require knowing the exact disease mechanism. Source of stem cells are convenient to get and it is extensive. There have no side effects as conventional treatment may create and its effects are established.
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