Evolución en el tratamiento del mieloma múltipleanálisis de su eficacia, complicaciones y factores de riesgo asociados

Abstract

Multiple myeloma (MM) is a frequent haematological neoplasm. It is still considered incurable, but the prognosis has significantly improved in the last 15 years. The aim of this study was to analyze the evolution of MM patients, diagnosed or treated at Morales Meseguer Universitary Hospital, in the last 28 years. We retrospectively reviewed the medical records of 403 MM patients. This series of patients has been divided into three groups according to the date of MM diagnosis: group A (1991-1999), group B (2000-2009) ) and group C (2010-2015). We observed that the diagnosis of MM has been made earlier in the last few years, and the number of cases has increased. Moreover, the patients diagnosed recently have a higher number of comorbidities. There also has been a change in the treatment schemes used, especially with the incorporation of those considered "new drugs", such as proteosome inhibitors and immunomodulatory agents (IMiDs). With these schemes, better response rate and a longer survival is obtained, benefit that is comparable to the published data. Our study also supports the use of autologous stem cell transplant, despite the more effective induction therapies that are currently available. On the other hand, treatment-related side effects have been evaluated. In more recent times, there has been an increase in the incidence of treatment-related myeloid neoplasia (NMRT), a risk that is superior with the administration of lenalidomide for more than 18 months; these NMRT have very poor prognosis and the cytogenetic characteristics are similar to those observed in myeloid neoplasms secondary to the use of alkylating agents. The severity of infections has decreased with the incorporation of new drugs; however, their impact on early mortality (before 6 months of diagnosis) has not changed, which continues to be relevant. Thirty-six percent of patients who received bortezomib, developed peripheral neuropathy. In addition, 15% of the global series presented a thrombotic event. We confirm that thromboprophylaxis has a protective effect only at the venous level and in patients treated with IMiDs. Hemorrhagic events have been infrequent and have occurred, mainly, during progression of the disease. Recently, our group has described a hemorrhagic diathesis mechanism in a patient, in which, the paraprotein exerted a heparin-like effect. We conducted a pilot study of 15 cases, which allowed us to identify a second patient with similar behavior and verify that this mechanism is independent of the immunoglobulin isotype involved in the monoclonal component.