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Multiple myeloma (MM) is an uncurable plasma cell malignancy, with incidence approximately 4 per 100 000 population and rich symptomatology causing often significant diagnostic problems. In 1992-2004 in Haematology Department of Medical University in Lublin MM was diagnosed in 197 patients (110 woman and 87 men, mean age 61± 11.2 years). The most common monoclonal protein type of was IgG, detected in 133 patients. At the time of initial diagnosis in 138 patients bone pain was a main complain, in 10,2% of these patients it was caused by pathological fractures. In 20 patients (10.2%) clinical course was indolent, and disease was diagnosed accidentally. In the other patients first clinical manifestation were unspecific symptoms, such as: general weeknes (15/197 patients), paraparesis (9/197), acute renal failure (8/197), prolonged infections (8/197) bone of soft tissue tumours (7/197). Taking into account unspecific clinical picture preliminary diagnostics should focus on characteristic for MM laboratory features, i.e.: highly accelerated erythrocyte sedimentation reaction resulted from hyper- and para-proteinaemia; proteinuria; osteolytic lesions in bone radiograms. Lack of appropriate diagnostic strategy prolongs time to therapy commencement to 5.3±4.7 months, in some cases even to 24 months. On the level of basic health care total protein serum level and bone radiograms are adequate diagnostic investigation to establish preliminary diagnosis of MM. In our study increase of total protein serum level and characteristic changes in bone radiograms were found in 96% of patients.
Multiple myeloma is a neoplastic disease which is characterised by proliferation of monoclonal plasmocytes in the bone marrow. It is the second most common hematologic cancer and it represents 1% of all cancer deaths. Despite enormous development in multiple myeloma biology and treatment over the last 30 years - it is still incurable disease with a median survival of 50 – 55 months. Currently, one of the most important goals in the treatment of multiple myeloma is to achieve long-term control of the disease, without negative impact on the patient’s quality of life. Thanks to therapeutic regimens based on new immunomodulatory drugs, this aim seems to be achievable. In this paper we present the case of a female patient living with multiple myeloma for 14 years. Initially patient was treated with standard VAD (vincristine, doxorubicin, dexamethasone) chemotherapy regimen. After a nearly complete remission of the disease, autotransplantation of hematopoietic cells was performed. One year after transplantation there was a relapse of the disease. In the treatment of relapse it was decided to use scheme based on lenalidomide and dexamethasone. After 4th cycle of treatment, a complete remission was achieved. So far, the patient received 149 cycles. In the evaluation of minimal residual disease still maintains a state of complete remission maintains. During over 12 years of treatment no complications in grade 3 and 4 of the CTCAE v.4 was observed. Currently the patient is 58 years old, she still receives lenalidomide and leads moderately active life.
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