INVESTIGATION OF THE MECHANISMS OF IMMUNE REACTIVITY AND DISORDERS OF BONE METABOLISM IN MULTIPLE MYELOMA

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In order to study the mechanisms of immune reactivity (IR) and bone metabolism (BM) disorders in groups of patients with initially diagnosed multiple myeloma (MM), with MM after standard therapy, with bone pathology of other etiology and elderly patients without bone pathology, markers of bone metabolism (MBM) were determined by immunochemical methods: Type 1 collagen N-terminal propeptide (P1NP), osteocalcin (fragment with amino group, N-MID), and β-aspartic acid of type I collagen C-telopeptides (β-crosslaps), immunoreactivity markers (IRM): C-reactive protein, β2-microglobulin, interleukin-6 and hormones (parathyroid hormone, free thyroxine (T4c.), total testosterone). It was revealed that in patients with primary MM, as a rule, there is a significant change in the levels of MBM and IRM. These changes in primary MM were detected much more often and were more pronounced than in patients with MM treated according to the standard program, patients without bone neoplasia and patients without bone pathology. There is a definite relationship between the intensity of IR and the severity of BM disorders. All this may indicate that in MM, bone tissue damage occurs as a result of a pronounced predominance of bone resorption over remodeling processes in conditions of the development of a chronic systemic inflammatory process with significant metabolic disorders. The result of these processes is the manifestation of a syndrome of bone and mineral disorders preceding the development of osteoporosis, which can be diagnosed using MBM, which therefore become significant indicators in the diagnosis of MM, assessment of bone tissue lesions before the appearance of clinical and instrumental signs of osteoporosis. It is also advisable to consider the possibility of using MBM for differential diagnosis, predicting the outcome of the disease, monitoring MM therapy and as indicators of the need to include drugs normalizing bone metabolism in the standard MM therapy regimen.