Multiple myeloma

diagnosis and treatment of multiple myeloma

At the Clinica Universidad de Navarra, we offer personalised treatment and follow-up. The drugs administered and their intensity are tailored to the characteristics of each patient.

In general, the treatment conducted at the Clinica Universidad de Navarra is based on the use of chemotherapy

Autologous haematopoietic stem cell transplantation is often performed after completing the chemotherapy, especially with patients younger than 65. This procedure is very useful for maintaining the response.

In recent years, we have witnessed the arrival of a significant number of new drugs for myeloma, including Bortezomib and Lenalidomide.

In addition, new therapies are in the research phase, such as the development of specific vaccines against myeloma (anti-idiotypic vaccines) and reduced-intensity allogeneic haematopoietic stem cell transplantation.

Occasionally, the diagnosis of myeloma in an asymptomatic individual is performed based on the detection of a monoclonal band in a laboratory test conducted as part of a check-up, company health review, etc.

The detection of a monoclonal component in blood or urine is not always synonymous with multiple myeloma. In fact, in most cases after a proper study, the diagnosis is monoclonal gammopathy of undetermined significance, a benign disorder that does not require treatment. However we monitor it over time, because in some cases it can transform into a myeloma.

Symptomatic patients

The study includes blood and urine analyses, bone marrow aspiration and an imaging study of the skeleton using magnetic resonance imaging [SP], bone scintigraphy [SP] and PET. These techniques detect early bone complications that are secondary to the disease, thereby enabling more effective treatment of the complications.

Thus, it is essential to perform flow cytometry (immunophenotype), cytogenetic (chromosome analysis) and a molecular biology study to identify the significant prognostic factors that can influence the choice of the most appropriate treatment for each patient.

Dr. San Miguel explains what is multiple myeloma and treatments exist for this disease. [Video only available in Spanish]

One of the areas in which we work the most is haematologic tumours. In myeloma, we have identified new therapeutic targets with genetic studies".

In general, the treatment of multiple myeloma is based on the use of chemotherapy. It is a systemic treatment in which one or more combined anticancer drugs are administered. Chemotherapy stops or delays the growth of cancer cells but can also affect healthy cells.

Autologous haematopoietic stem cell transplantation is often performed after completing the chemotherapy, especially with patients younger than 65. This procedure is very useful for maintaining the response.

Atypical cells, which are produced when there is a myeloma, originate 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 kidney function. The simultaneous application of chemotherapy to reduce the plasma cells (which produce the light chains) and dialysis [SP] (which effectively eliminates these chains) increases the possibilities of a better recovery of kidney function.

The objective of this procedure is to restore the function of bone marrow cells.

The Clinic has over 20 years of experience in haematopoietic stem cell transplantation. Since 1989, the Clinica Universidad de Navarra has performed haematopoietic stem cell transplantations (from bone marrow), both autologous (the patient is the donor) and allogeneic (another individual is the donor).

The treatment is conducted in a multidisciplinary manner and involves the following departments: Haematology, Oncology, Paediatrics [SP], Blood Bank and Immunology [SP].

Haematopoietic stem cell transplantation is employed for neoplastic diseases (malignant tumours) and diseases of bone marrow function (blood cell producer) diseases. The procedure also treats immune system diseases and a number of congenital metabolic disorders.

Haematopoietic stem cells are obtained from bone marrow. Currently, they are mostly extracted from the blood and occasionally from the umbilical cord and placenta. These cells are found in the interior of the bone marrow (especially from the hip, vertebrae and ribs) but are occasionally increased in number in the circulation, and can therefore also be obtained from the veins.

The objective of this procedure is to restore the function of the bone marrow so that it can produce blood cells normally.

The Haematopoietic Transplantation Area is currently conducting open clinical trials for pretransplant conditioning with radioimmunotherapy (for both autologous and allogeneic transplantation) and for the treatment of graft-versus-host disease using mesenchymal bone marrow stem cells produced in the GMP Laboratory.

> Read more about haematopoietic stem cell transplantation

The application of monoclonal antibodies is one of the treatments that has most revolutionised the therapy for myeloma.

It consists of proteins directed against other proteins on the surface of the tumour cells (antigens) and therefore represents a much more specific treatment against the tumour. The treatment is often combined with chemotherapy.

At the Clinica Universidad de Navarra, this treatment 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. The most widely used antibody is anti-CD20, which binds to lymphoid cells and induces their destruction.

Furthermore, in coordination with the Department of Nuclear Medicine [SP], we have begun to use other types of monoclonal antibodies that add (to the effectiveness of anti-CD20) the action of a radioactive isotope to which they are attached.

The Clínica Universidad de Navarra is the first centre in the world to initiate a clinical trial on the treatment of myeloma that includes allogeneic transplantation and the vaccination of donor and recipient with an anti-idiotypic vaccine.

Its objective is to generate an immune reactionin patients whose disease is in its first stages or in patients whose disease is in remission. The use of this type of vaccination, which was created to cause an immune response, is being studied in several types of lymphoproliferative syndromes.

The same laboratory has developed specific vaccines against the proteins produced by myeloma cells, while simultaneously using other immunotherapy strategies with dendritic cells.

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