Multiple myeloma

learn more about multiple myeloma

Multiple myeloma is a common disease that consists of the atypical proliferation of plasma cells.

It is part of the group of disorders known as monoclonal gammopathies. These cells are derived from B lymphocytes and, in normal conditions, produce immunoglobulins, which are proteins that are necessary for fighting infections.

These atypical cells produce and secrete an abnormal immunoglobulin into the blood, which produces an excess of light chains that the kidneys are not able to effectively eliminate and can cause irreversible damage to the kidney function.

They also accumulate in the bone marrow and promote bone degeneration, causing osteolytic lesions and bone petrification.

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Multiple myeloma [Infography only available in Spanish]
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Multiple myeloma mainly affects older individuals (over 50), with an incidence that increases with age.

The symptoms of the disease are basically the results of the uncontrolled proliferation of plasma cells in the bone marrow. These cells displace normal cells, causing symptoms of anaemia with its associated symptoms (fatigue, pallor, tachycardia, flushing, etc.).

It also causes bone destruction, which can cause moderate to intense bone pain and even spontaneous fractures or fractures under minimal trauma.

Additionally, the atypical cells produce and secrete an abnormal immunoglobulin into the blood (monoclonal component or band), which when filtered by the kidneys can cause kidney failure.

Kidney impairment in multiple myeloma is one of the most common complications, occurring in 50% of cases. Kidney failure is the main cause of morbidity and mortality in patients afflicted with myeloma.

Other clinical manifestations are related to the increase in blood calcium levels due to bone destruction, neurological compression, etc.

The origin of multiple myeloma is unclear, as with many neoplastic diseases in which new tissue growth occurs. Nevertheless, various factors could be involved in its development, such as viral infections, drugs, chemical products and exposure to radiation.

However, in most cases, it is not possible to identify a trigger for the disease. Certain DNA changes can cause plasma cells to become cancerous. DNA is the chemical that provides instructions for almost all of our cells’ functions.

Cancer is known to occur due to errors or defects, the so-called DNA mutations, which can trigger oncogenes or deactivate tumour suppressor genes.

The new therapeutic modalities provide a glimpse of improvements in the prognosis.

The prognosis for multiple myeloma depends, among other factors, on the stage in which the disease is found. Until a few years ago, the disease had high mortality within a short time period after the diagnosis; however, the new treat provide improved short-term prognoses.

Specifically, at the Clinica Universidad de Navarra, treatment with monoclonal antibodies has been jointly administered with chemotherapy to more than a hundred patients, and its use has raised the response rate achieved with just chemotherapy by a significant percentage.

Kidney impairment in multiple myeloma is one of the most common complications, occurring in 50% of cases. Kidney failure is the main cause of morbidity and mortality in patients with myeloma.

The atypical myeloma cells produce and secrete an abnormal immunoglobulin into the blood, which produces an excess of light chains that the kidneys are not able to effectively eliminate and can cause irreversible damage to the kidney function.

The simultaneous application of chemotherapy to reduce the plasma cells (which produce the light chains) and another treatment that effectively eliminates these chains increases the possibilities of a better recovery of kidney function.

Clinical research studies have indicated that the reduction in the time of kidney exposure to light chains at toxic levels reduces the risk of developing permanent kidney failure.

Among the high-permeability dialysis filters that have been studied, the HCO 1100 has been shown to be effective in the elimination of these chains. This filter is attached to a conventional haemodialysis system. No adverse effects have been reported from its use, and the only recommendation is to monitor electrolyte and albumin levels.

Indication

  • Patients diagnosed with multiple myeloma with excess free light chains and associated kidney failure (attributable to this cause) for whom chemotherapy for the myeloma has been scheduled.

The Department of Nephrology [SP], in close cooperation with the Department of Haematology, performs this type of haemodialysis as adjuvant treatment in chemotherapy for patients with multiple myeloma who meet the inclusion criteria.

We have the most sophisticated developments, such as molecular biology studies, to assess the multiple prognostic factors that are essential for selecting the most appropriate treatment for each patient.”

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