Епідеміологічні дані, етіологія, патогенез, фактори ризику, клінічні прояви, сучасні методи діагностики і лікування, прогнозування перебігу множинної мієломи (огляд літератури)

Автор(и)

  • Г.Р. Савуляк Львівський національний медичний університет імені Данила Галицького, Львів, Україна https://orcid.org/0000-0002-8835-3147
  • В.Л. Новак ДУ «Інститут патології крові та трансфузійної медицини НАМН України», Львів, Україна https://orcid.org/0000-0002-5979-5018

DOI:

https://doi.org/10.26641/1997-9665.2024.1.6-18

Ключові слова:

множинна мієлома, плазмоцитарна мієлома, ВДХТ, аутоТГСК.

Анотація

Актуальність. Множинна мієлома (ММ) – це неопластичне захворювання з багатоетапним перебігом, що характеризується неконтрольованою, багатовогнищевою проліферацією моноклональних плазмоцитів в кістковому мозку, які продукують моноклональний імуноглобулін або лише його фрагменти, які призводять до руйнування кісткової тканини та пошкодження органів. Доволі високі показники як захворюваності, так і смертності від ММ вимагають ретельнішої уваги і глибшого наукового дослідження цієї проблеми. Мета – дослідити епідеміологію, етіологію, патогенез, фактори ризику, клінічні прояви, сучасні методи діагностики та лікування, а також прогнозування перебігу ММ. Методи. Використано такі методи дослідження: пошук, вилучення і обробка інформації; оцінка якості джерел; систематичний огляд літератури; аналіз змісту. Матеріали дослідження становлять тематичні публікації українських й іноземних науковців. Результати. ММ становить ~1 % усіх злоякісних новоутворень і ~14 % гематологічних новоутворень у світі. Етіологічні фактори ММ: генетична схильність, бактеріальні або вірусні інфекції, іонізуюче випромінювання, канцерогенні токсини. Клінічний синдром ММ характеризується гіпергаммаглобулінемією, гіперкальціємією, сприйнятливістю до інфекцій, патологічними переломами. Діагностика ММ включає: загальний аналіз периферичної крові; діагностику білків сироватки і сечі; аспіраційну біопсію і трепанобіопсію кісткового мозку; цитогенетичну і молекулярну діагностику; іншу лабораторну діагностику; РГ, КТ, МРТ і ПЕТ-КТ. Основні методим лікування ММ: ПТ, ХТ, комбінована ХТ з включенням нових лікарських препаратів, ВДХТ + аутологічна ТГСК. Прогнозування перебігу ММ залежить від стадії R-ISS, рівня ЛДГ і цитогенетики високого ризику. Підсумок. Упродовж останніх років сучасної онкогематології спостерігаємо наукові досягнення у діагностуванні та лікуванні ММ. Проведенню ефективної діагностики та вибору оптимальної стратегії і тактики лікування, а також визначенню прогнозу перебігу ММ сприяють ґрунтовне вивчення епідеміології, етіології і патогенезу, факторів ризику та клінічних проявів ММ.

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