Multiple myeloma (MM) is a proliferative trastorn of the B clones that is characterized by an accumulation of plasmatic cells (CP) malignant at the level of the oceanic medium, and conducts a specific organ of diana organs.
Agencia Latina de Noticias Medicina y Salud Pública
Has part of the spectrum of monoclonal gamma-ray and represents 1% of all neoplasia lesions and 10% of hematologic neoplasias. Predominantly occurring in the adult population with a median age at the time of diagnosis of 65 years, has a proportion of males in females from 3 to 2 and is most frequent in African Americans. The patient survival rate with MM is approximately 3 years old and there is an urgent need for superior survivors up to 10 years. It was created to form a stage for malignancy and asymptomatic denomination of indeterminate monoclonal gamma (GMSI). The GMSI is present at more than 3% of the mayor’s population of 50 years and progresses with a rate of 1% per year. The excess of monoclonal immunoglobulin can cause hyperviscosity, placental dysfunction and renal tubular dysfunction, which leads to neurological disorders, hemorrhages and renal insufficiency. Occupation of the medium is by the clone of plasmatic cells manifested as anemia, thrombocytopenia and leukopenia.
The initial MM therapy depends on the assessment of the risk of illness and the functional state, which will help to determine the flexibility for transplanting hematopoietic progenitor cells. Patients in need of transplantation generally receive induction therapy to reduce the tumor load, followed by mobilization and recovery of cells from peripheral blood. There are different therapies for maneuvering, including those involving immunomodulators (IMiDs), which include Talidomida, Lenalidomida and Pomalidomida; its mechanism of action includes the reduction of cytokine production and growth factors, the induction of tumor suppressor genes that lead to the cell cycle and the activation of apoptosis caspases. These drugs generate a DNA-level donation through free radicals, as well as anti-angiogenic action, immunomodulatory and inhibition of tumor necrosis factor. It was agreed that the lenalidomide and pomalidomide have a mayor effective tumoricide that thalidomide.
Lenalidomide inhibits the proliferation and increases the apoptosis of tumor hematopoietic cell determinants (between them the multiple plasmatic cells in the multiple myeloma, the tumor cells of the follicular lineage, moordenaar (NK) .Diminute the secretion of interleukina 6 (IL-6) and the Vascular Endothelial Growth Factor (VEGF), which have different effects on migration and tumor growth. of endothelial cells and microvascular formation Lenalidomide is the most widely used dose dose (Rd) is an oral regimen effective for the initial therapy of MM. in patients treated with lenalidomide and dexamethasone, additionally the lenalidomide can cause neutropenia and thrombus important ocitopenia and is contraindicated.
Pomalidomide is a drug with immunomodulatory activity, capable of inhibiting the support of the cells of the current for the healing of the neoplasic cells of the MM. It has been found that the pomalidomide inhibits the proliferation of multiple myeloid cell lines resistant to lenalidomide and presents a synergistic effect with dexamethasone in the apoptosis of tumor cells. Intensify the cellular medium mediated by linfocytos T y NK and inhibit the production of TNF-α by the monocytes, which allows the cancer to develop by means of the modulation of cellular adhesion interactions of the myeloma cells with the tumor microbial. In addition, it regulates in a negative manner the cellular adhesion molecules and decreases the secretion of IL-6 and VEGF, both important factors for the survival and proliferation of MM cells. It was indicated in patients with multiple myeloma that he received at least two previous therapies, including lenalidomide and bortezomib and he demonstrated the progression of the disease within 60 days of the finalization of the ultimate therapy. The International Myeloma Working Group (IMWG) Uniform Response Criteria are the preferred criteria for determining the patient’s best response to treatment and to define when an event has taken place, considered as progressive progression (EP) by 25 per cent. value of the most low in each of the following: an increase of the specific protein M ≥1 g / dL denota EP, if the component M has a higher yield of ≥5 g / dL, an absolute increase of the protein M in orange ser ≥200 mg / 24 hours), Diferencia in the CLL kappa and lambda (the absolute increase should be> 10 mg / dL), an absolute increase of ≥10 per cent percentage of plasma cells of the oceanic medium. Diagnosis is also made when there is an increase of ≥50 per cent in the development or development of new lesions or plasmacytomas of mixed tejidos.