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If there are no symptoms, but a paraprotein typical of myeloma and diagnostic bone marrow is present without end-organ damage, treatment is usually deferred or restricted to clinical trials. [105] Treatment for multiple myeloma is focused on decreasing the clonal plasma cell population and consequently decrease the symptoms of disease.
The concept of the tumor microenvironment (TME) dates back to 1863 when Rudolf Virchow established a connection between inflammation and cancer. However, it was not until 1889 that Stephen Paget's seed and soil theory introduced the important role of TME in cancer metastasis, highlighting the intricate relationship between tumors and their surrounding microenvironment.
Bone marrow suppression due to anti-cancer chemotherapy is much harder to treat and often involves hospital admission, strict infection control, and aggressive use of intravenous antibiotics at the first sign of infection. [7] G-CSF is used clinically (see Neutropenia) but tests in mice suggest it may lead to bone loss. [8] [9]
Myeloid-derived suppressor cells (MDSC) are a heterogeneous group of immune cells from the myeloid lineage (a family of cells that originate from bone marrow stem cells). MDSCs expand under pathologic conditions such as chronic infection and cancer, as a result of altered haematopoiesis . [ 1 ]
HDC can depress bone marrow, which lowers platelets, red blood cells, and white blood cells while raising the risk of bleeding, infections, and anemia. [18] Treatment for cancer frequently has this side effect, which can be managed with the use of cytokines such G-CSF and EPO. [19]
All cancer treatment modalities (e.g., chemotherapy, targeted drugs, radiation and surgery) trigger systemic and local effects in the treated subject (i.e., the host). These include a rapid elevation in the levels of circulating cytokines , chemokines , growth factors and enzymes accompanied by acute mobilization and tumor homing of bone-marrow ...
Bone is the third most common location for metastasis, after the lung and liver. [13] While any type of cancer is capable of forming metastatic tumors within bone, the microenvironment of the marrow tends to favor particular types of cancer, including prostate, breast, and lung cancers. [4]
The more aggressive forms of disease require treatment with chemotherapy, radiotherapy, immunotherapy and—in some cases—a bone marrow transplant. The use of rituximab has been established for the treatment of B-cell–derived hematologic malignancies, including follicular lymphoma (FL) and diffuse large B-cell lymphoma (DLBCL). [7]