Multiple myeloma. Practical aspects regarding diagnosis and treatment Review article
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Abstract
Practical aspects of multiple myeloma diagnosis and treatment has been discussed. Myeloma diagnosis should be supported with immunoglobulin’s isotype and serum free light chain immunoglobulins studies. It is particularly important in non- or oligosecretory mullti (ple myelomas patients. Bone marrow flow cytometry and immunohistochemistry bone marrow studies with monoclonal antibodies against CD38, CD138, CD19, CD-20, CD56 and light chain staining should be performed. Treatment of patients which who are candidates for treatment with high dose therapy with autologous bone marrow transplantation should consist of cyclophosphamide, thalidomide and dexamethasone (CTD) chemotherapy, less commonly treatment with bortezomide/dexamethasone should be considered. Patients not stratified to high dose therapy should receive chemotherapy consists of melphalan, prednisone, thalidomide (MPT) or attenuated (CTDa) chemotherapy. Second line treatment includes bortezomib containing regimens. Most commonly bortezomib/ /dexamethasone chemotherapy has been used. Primary resistant myelomas patients should receive ESHAP (etoposdide, methyprednisolone, cis-platin, cytosine arabinoside) chemotherapy followed by autologous bone marrow transplantation, or early usage bortezomib containing regimens. High risk myeloma’s patients are treated in United Stated with inductive therapy as patients planned for high dose chemotherapy followed by autologous bone marrow transplantation followed by lenalidomide or lenalidomide/dexamethasone therapy, early bortezomibe containing regfimens induction’s protocols followed by high dose therapy or high dose therapy followed by miniallotransplantation (reduce intensity conditionning allotransplantation).
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Copyright: © Medical Education sp. z o.o. This is an Open Access article distributed under the terms of the Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). License (https://creativecommons.org/licenses/by-nc/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
Address reprint requests to: Medical Education, Marcin Kuźma (marcin.kuzma@mededu.pl)
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