Chemotherapy and Immunotherapy for Multiple Myeloma

Overview of Immune System Disorders and Their Management

• Multiple Sclerosis (MS) is an autoimmune disease characterized by periods of relapse and remission.

• MS is diagnosed through tests that measure immune cell subsets, B-cell antibodies, and other markers.

• Females are affected by MS twice as often as males.

• MS can be detected through MRI scans, elevated IgG levels in the cerebrospinal fluid, and decreased conduction velocity.

• Treatment for MS includes disease-modifying agents, corticosteroids, plasma exchange, and antineoplastic agents.

• Anesthesia for MS patients should avoid hyperthermia and minimize changes in fluid homeostasis and central hemodynamics.

• Rheumatoid Arthritis (RA) is an inflammatory autoimmune disease that affects smaller joints and can spread to larger joints.

• RA is characterized by synovial inflammation, cartilage and bone destruction, and systemic features.

• T cells, B cells, and abnormal production of cytokines play a role in the development of RA.

• Diagnostic tests for RA include elevated ESR and CRP levels, presence of RF and anti-CCP antibodies, and imaging findings.

• Treatment for RA involves disease-modifying antirheumatic drugs (DMARDs), NSAIDs, corticosteroids, and surgical procedures.

• Systemic Lupus Erythematosus (SLE) is an autoimmune disease with widespread effects on various organs.

• SLE is characterized by the presence of autoantibodies, butterfly-shaped rash, mouth sores, arthritis, renal impairment, and abnormal blood tests.

• Treatment for SLE includes avoiding triggers, NSAIDs, corticosteroids, immunosuppressants, and B-lymphocyte stimulator-specific inhibitors.

• Type I Diabetes Mellitus is an autoimmune disease that results in the destruction of insulin-producing cells in the pancreas.

• Treatment for Type I Diabetes involves insulin replacement therapy.

• Primary Immunodeficiency Disorders (PIDDs) are genetic defects in cells of the immune system, leading to increased susceptibility to infections.

• PIDDs can be classified based on the affected immune cells and associated features.

• Treatment for PIDDs includes supportive care, bone marrow transplantation, and biologic modifiers.

• Acquired Immune Deficiency (AID) can be caused by various factors such as severe malnutrition, infections, and immunosuppressant drugs.

• AID affects both the innate and adaptive immune systems.

• Treatment of the primary condition usually improves the associated AID.

• Acquired Immune Deficiency Syndrome (AIDS) is caused by the Human Immunodeficiency Virus (HIV), which attacks CD4 T-cells.

• Diagnosis of AIDS involves testing for HIV antigen and antibodies, as well as monitoring CD4 T-cell count.

• Treatment for AIDS aims to suppress viral load with antiretroviral therapy.

• Cancers of the immune system include leukemia and lymphoma.

• LeChemotherapy and Immunotherapy for Multiple Myeloma

• Multiple Myeloma, also known as Kahler disease, is the most common type of myeloma.

• It is caused by a mutation in plasma B cells, leading to the rapid proliferation of abnormal myeloma cells that interfere with the production of white blood cells, red blood cells, and platelets.

• Myeloma cells produce monoclonal proteins or M proteins, which accumulate into plasmacytomas that erode the bone cortex, causing osteoporosis and bone fractures, and are also deposited in organs throughout the body.

• Symptoms of multiple myeloma include anemia, bleeding, bone lesions and pain, hypercalcemia, and renal failure.

• Multiple myeloma is staged based on the degree of anemia, number of M proteins, and renal damage.

• Diagnosis is confirmed through a bone marrow biopsy.

• Treatment options for multiple myeloma include chemotherapy and glucocorticoids, targeted drug therapy with proteasome inhibitors, immunomodulating drugs, monoclonal antibodies (MABs), interferon, bisphosphonates, and recombinant parathyroid hormone.

• MABs are laboratory-engineered molecules that attach to abnormal cells and mark them for identification and destruction by the immune system.

• MABs are used in the treatment of cancers and to prevent rejection of transplanted organs.

• Examples of MABs used in cancer treatment include rituximab, cetuximab, bevacizumab, and ado-trastuzumab emtansine.

• Radioimmunotherapy combines a MAB with a radioactive isotope to target and destroy cancer cells.

• Autologous or allogeneic hematopoietic stem cell transplantation (HSCT) may be used for advanced stages of multiple myeloma following high-dose chemotherapy.