{"id":5220,"date":"2024-12-11T18:01:33","date_gmt":"2024-12-11T17:01:33","guid":{"rendered":"https:\/\/irccs.com\/patologie\/myelomas\/"},"modified":"2026-06-23T12:15:47","modified_gmt":"2026-06-23T10:15:47","slug":"myelomas","status":"publish","type":"pathology","link":"https:\/\/inoc.it\/en\/pathology\/myelomas\/","title":{"rendered":"Multiple Myeloma"},"content":{"rendered":"\n<h2 class=\"wp-block-heading\"><span  id=\"pathology\" class=\"h2_anchor\"><\/span>Pathology<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Multiple myeloma (MM)<\/strong> is a <strong>blood cancer<\/strong> that arises from a transformation of <strong>plasma cells<\/strong>, immune system cells derived from <strong>B lymphocytes<\/strong>. Under normal conditions, plasma cells produce <strong>antibodies<\/strong> that help protect the body against infections.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">When these cells become malignant, they proliferate in an <strong>uncontrolled and abnormal manner<\/strong>, leading to damage of the <strong>bone marrow, bones, and other organs<\/strong>, and impairing the production of healthy blood cells.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Types of Plasma Cell Disorders<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">In addition to multiple myeloma, other plasma cell disorders include:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Monoclonal gammopathy of uncertain significance (MGUS)<\/strong>: a <strong>benign condition<\/strong> characterized by a small population of abnormal plasma cells (<strong>&lt;10% in bone marrow<\/strong>) without symptoms. It is often detected incidentally and does not require treatment, only <strong>regular follow-up<\/strong>.<\/li>\n\n\n\n<li><strong>Solitary plasmacytoma<\/strong>: a <strong>localized accumulation of malignant plasma cells<\/strong> in bone or soft tissue, without systemic bone marrow involvement. It is usually treated with <strong>local therapies<\/strong>, particularly <strong>radiotherapy<\/strong>.<\/li>\n\n\n\n<li><strong>Amyloidosis<\/strong>: a condition in which abnormal plasma cells produce <strong>amyloid proteins<\/strong> that accumulate in organs and tissues, impairing their function.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Distinguishing these conditions is essential, as each requires a <strong>different clinical approach<\/strong>, ranging from monitoring to specific treatment.atments.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">The Numbers in Italy<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Multiple myeloma accounts for approximately <strong>1.6% of all cancers in men<\/strong> and <strong>1.5% in women<\/strong>, with a slightly higher incidence in males.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Each year, about <strong>6,000 new cases<\/strong> are diagnosed in Italy, a number that is increasing due to improved diagnostic accuracy. Today, the goal of hematological treatment is not only disease control but also transforming multiple myeloma into a <strong>chronic, manageable condition<\/strong>, maintaining a good <strong>quality of life<\/strong>.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"symptoms\" class=\"h2_anchor\"><\/span>Symptoms<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The most common signs and symptoms include:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Anemia<\/strong>, causing fatigue, pallor, and shortness of breath<\/li>\n\n\n\n<li><strong>Hypercalcemia<\/strong>, which may cause irritability, confusion, drowsiness, nausea, constipation, and loss of appetite<\/li>\n\n\n\n<li><strong>Renal impairment<\/strong>, with elevated creatinine levels that may progress to acute kidney failure requiring dialysis<\/li>\n\n\n\n<li><strong>Bone pain<\/strong>, often associated with <strong>pathological fractures<\/strong>, particularly in the vertebrae, ribs, pelvis, and femur<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">These symptoms are <strong>not specific<\/strong> to multiple myeloma and may occur in other conditions. However, in the presence of a <strong>monoclonal component<\/strong>, hematological evaluation is indicated.ly investigated causes or if they are associated with the presence of a monoclonal component, evaluation by the hematologist is appropriate.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"risk-factors\" class=\"h2_anchor\"><\/span>Risk Factors<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The exact causes of multiple myeloma are not fully understood. However, the disease is strongly associated with <strong>advancing age<\/strong>, with nearly <strong>40% of diagnoses occurring in patients over 70 years old<\/strong>, and only about <strong>2% in patients under 40<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Multiple myeloma is often preceded by <strong>MGUS<\/strong>, a generally asymptomatic condition that requires <strong>regular monitoring<\/strong>, as it may in some cases progress to overt disease.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"diagnosis-and-examination\" class=\"h2_anchor\"><\/span>Diagnosis and Examination<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Diagnosis often begins after the detection of suspicious symptoms or an incidental finding of a <strong>monoclonal component<\/strong> in blood or urine.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Key diagnostic tests include:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Serum protein electrophoresis<\/strong><\/li>\n\n\n\n<li><strong>Serum free light chain assay<\/strong><\/li>\n\n\n\n<li><strong>24-hour urine collection with detection of Bence Jones protein<\/strong><\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">The presence of a monoclonal component is not specific to multiple myeloma and requires clinical interpretation by a specialist. If suspected, second-level investigations are performed.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">These include:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Radiological imaging studies<\/li>\n\n\n\n<li><strong>Bone marrow biopsy and aspirate<\/strong><\/li>\n\n\n\n<li>Other targeted biopsies<\/li>\n<\/ul>\n\n\n\t<div id=\"block_6a3a5cd1f32f6\" class=\"accordion-block acf-block\">\n\t\t<div class=\"my-4 lg:my-6\">\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Bone Marrow Biopsy and Bone Marrow Aspiration<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p class=\"isSelectedEnd\"><strong>Bone marrow biopsy and bone marrow aspiration<\/strong> are performed to determine whether <strong>tumor plasma cells<\/strong> are present in the bone marrow.<\/p>\n<p class=\"isSelectedEnd\">If <strong>more than 10% of bone marrow cells<\/strong> are plasma cells, the diagnosis of <strong>multiple myeloma<\/strong> is confirmed. If plasma cells account for <strong>less than 10%<\/strong>, the condition is classified as <strong>monoclonal gammopathy of uncertain significance (MGUS)<\/strong>, a non-pathological condition that does not require treatment but only <strong>clinical monitoring<\/strong>.<\/p>\n<p class=\"isSelectedEnd\">The procedure is performed on an <strong>outpatient basis under local anesthesia<\/strong> and consists of aspirating a small amount of <strong>bone marrow blood<\/strong> and obtaining a <strong>small bone fragment from the pelvis<\/strong>. Samples are then sent to <strong>anatomical pathology<\/strong> for evaluation.<\/p>\n<p>In addition to <strong>histological examination and immunophenotyping<\/strong>, which allow quantification and characterization of plasma cells, bone marrow aspiration also enables <strong>cytogenetic analysis (FISH)<\/strong>. This test identifies specific <strong>chromosomal abnormalities<\/strong> associated with more aggressive disease behavior and is essential for <strong>disease staging and risk assessment<\/strong>.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Other Biopsies<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p class=\"isSelectedEnd\">In cases where an <strong>isolated plasmacytoma<\/strong> is suspected, defined as a <strong>localized accumulation of tumor plasma cells<\/strong> in a single bone site or other organ without evidence of diffuse bone marrow involvement, a <strong>biopsy of the lesion itself<\/strong> is performed. This allows for <strong>histological confirmation of the diagnosis<\/strong>.<\/p>\n<p class=\"isSelectedEnd\">When <strong>amyloidosis<\/strong> is suspected, physicians may request a biopsy of <strong>periumbilical fat<\/strong> or <strong>minor salivary glands<\/strong>, as these are common sites where the abnormal protein produced by plasma cells (the <strong>amyloid substance<\/strong>) tends to accumulate.<\/p>\n<p class=\"isSelectedEnd\">The <strong>periumbilical fat biopsy<\/strong> is a simple, rapid, outpatient procedure performed without anesthesia, consisting of the removal of small fragments of fat tissue near the umbilicus. The <strong>salivary gland biopsy<\/strong> is instead performed by a <strong>specialist in ear, nose, and throat medicine (ENT)<\/strong>.<\/p>\n<p>In rarer cases, the <strong>amyloid substance<\/strong> may be detected directly in the affected organ, such as the <strong>kidney, intestine, or stomach<\/strong>, through a <strong>targeted biopsy<\/strong>.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Radiological Examinations<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p class=\"isSelectedEnd\">Several imaging examinations are used to detect the typical bone lesions of multiple myeloma, known as <strong>osteolytic lesions<\/strong>.<\/p>\n<p class=\"isSelectedEnd\">The first-line examination is a <strong>whole-body low-dose CT scan (computed tomography)<\/strong> performed <strong>without contrast medium<\/strong>. This technique evaluates all skeletal regions to identify the presence of bone lesions.<\/p>\n<p class=\"isSelectedEnd\">As an alternative, a <strong>PET-CT scan (positron emission tomography combined with CT)<\/strong> may be performed. This examination identifies bone lesions as <strong>metabolically active areas<\/strong> and requires the administration of a <strong>radiolabeled glucose tracer<\/strong>. A key advantage of PET-CT is its ability to assess <strong>treatment response<\/strong>, which is more challenging to evaluate with CT alone.<\/p>\n<p class=\"isSelectedEnd\">In addition to or instead of these methods, an <strong>MRI (magnetic resonance imaging)<\/strong> of the spine and pelvis or a <strong>whole-body MRI<\/strong> may be requested. This examination is performed <strong>without contrast medium<\/strong>, takes longer to complete, but offers <strong>higher sensitivity<\/strong> compared to CT in detecting bone marrow involvement.<\/p>\n<p>The choice among these imaging techniques is determined by the physician based on the <strong>patient\u2019s characteristics and disease features<\/strong>.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\n\t<\/div>\n\n\n\n<h3 class=\"wp-block-heading\">Staging<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">To determine the stage of <strong>multiple myeloma<\/strong>, blood tests are performed to measure <strong>albumin, beta-2 microglobulin, and LDH levels<\/strong>, along with the <strong>cytogenetic FISH analysis<\/strong> conducted on a bone marrow aspirate sample.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The combination of these assessments defines <strong>three stages of disease<\/strong>, reflecting increasing biological aggressiveness and a progressively different prognosis. While treatment is generally similar across stages, staging is essential for <strong>clinical monitoring during therapy<\/strong>.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Evaluation of Organ Function<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">To support the selection of an effective treatment with acceptable toxicity, additional instrumental tests may be required, including <strong>echocardiography<\/strong>, which evaluates <strong>cardiac function<\/strong>, and <strong>spirometry<\/strong>, which assesses <strong>lung function<\/strong>.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"therapies\" class=\"h2_anchor\"><\/span>Therapies<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">After the diagnosis is confirmed, the <strong><a href=\"https:\/\/inoc.it\/en\/pathology\/myelomas\/\">multidisciplinary team<\/a><\/strong> evaluates multiple clinical factors to develop an <strong>individualized treatment plan<\/strong> for each patient.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Treatment options for multiple myeloma may include <strong>immunotherapy, biologic agents, chemotherapy, autologous stem cell transplantation, corticosteroids, and radiotherapy<\/strong>.<\/p>\n\n\n\t<div id=\"block_6a3a5cd1f336e\" class=\"accordion-block acf-block\">\n\t\t<div class=\"my-4 lg:my-6\">\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Immunotherapy<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p class=\"isSelectedEnd\"><strong>Immunotherapy<\/strong> uses treatments that help the immune system recognize and attack cancer cells or restore the body&#8217;s natural ability to fight the disease.<\/p>\n<p class=\"isSelectedEnd\">The main immunotherapy approaches used in the treatment of <strong>multiple myeloma<\/strong> include:<\/p>\n<ul data-spread=\"true\">\n<li><strong>Monoclonal antibodies:<\/strong> laboratory-produced antibodies designed to recognize specific markers found on myeloma cells. Once they bind to their target, they trigger the destruction of the cancer cells.<\/li>\n<li><strong>Antibody-drug conjugates (ADCs):<\/strong> monoclonal antibodies linked to substances that are toxic to cancer cells. After binding to their target on the tumor cell, they deliver the toxic agent directly into the cell, leading to its destruction.<\/li>\n<li><strong>Bispecific antibodies:<\/strong> engineered antibodies that simultaneously recognize a marker on myeloma cells and a marker on immune cells. By bringing these cells into close contact, they stimulate the immune system to attack and eliminate the cancer cells.<\/li>\n<li><strong>CAR T-cell therapy:<\/strong> one of the most innovative treatments for multiple myeloma. T lymphocytes are collected from the patient&#8217;s blood and genetically modified in a specialized laboratory to recognize a specific marker on myeloma cells. Once reinfused into the bloodstream, these modified cells can identify and destroy cancer cells. CAR T-cell therapy is administered as a <strong>single infusion<\/strong> and requires <strong>hospital admission<\/strong> to monitor and manage potential side effects associated with immune activation.<\/li>\n<\/ul>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Biologic Agents<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p class=\"isSelectedEnd\"><strong>Biologic agents<\/strong> are drugs that interfere with specific cellular pathways involved in the growth and survival of myeloma cells, leading to their destruction.<\/p>\n<p class=\"isSelectedEnd\">These therapies include:<\/p>\n<ul data-spread=\"false\">\n<li><strong>Proteasome inhibitors<\/strong>, such as <strong>bortezomib<\/strong> and <strong>carfilzomib<\/strong><\/li>\n<li><strong>Immunomodulatory agents<\/strong>, such as <strong>thalidomide<\/strong>, <strong>lenalidomide<\/strong>, and <strong>pomalidomide<\/strong><\/li>\n<\/ul>\n<p>These drugs are commonly used in combination with other therapies as part of the treatment strategy for <strong>multiple myeloma<\/strong>.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Chemotherapy<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p class=\"isSelectedEnd\"><strong>Chemotherapy<\/strong> uses drugs that destroy cancer cells by targeting their <strong>rapid growth and division<\/strong>.<\/p>\n<p>Because chemotherapy interferes with cellular replication, it can also affect some healthy cells in the body, leading to <strong>side effects<\/strong>. These effects are generally <strong>temporary<\/strong>, tend to resolve after treatment is completed, and can often be effectively managed with <strong>modern supportive therapies<\/strong>.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Stem Cell Transplantation<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p class=\"isSelectedEnd\"><a href=\"https:\/\/inoc.it\/en\/medical-area\/hemopoietic-stem-cell-transplantation-and-cellular-therapies-center\/\"><strong>Autologous stem cell transplantation<\/strong><\/a> allows the administration of <strong>high-dose chemotherapy<\/strong>, with the aim of eliminating as many myeloma cells as possible.<\/p>\n<p class=\"isSelectedEnd\">Because high-dose chemotherapy can temporarily damage the <strong>bone marrow<\/strong>, previously collected <strong>stem cells<\/strong> are reinfused after treatment. This enables the bone marrow to recover more rapidly and restore the production of <strong>red blood cells, white blood cells, and platelets<\/strong>.<\/p>\n<p>This procedure is performed during a <strong>hospital admission<\/strong>, which typically lasts <strong>approximately three weeks<\/strong>.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Radiotherapy<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p class=\"isSelectedEnd\"><a href=\"https:\/\/inoc.it\/en\/medical-area\/radiotherapy\/\"><strong>Radiotherapy<\/strong> <\/a>is a treatment that uses <strong>high-energy radiation<\/strong> to destroy cancer cells.<\/p>\n<p class=\"isSelectedEnd\">In <strong>multiple myeloma<\/strong>, radiotherapy is used primarily for <a href=\"https:\/\/inoc.it\/en\/medical-area\/pain-therapy-and-palliative-care\/\"><strong>pain relief<\/strong><\/a>, helping to reduce symptoms caused by <strong>osteolytic lesions<\/strong> or <strong>localized collections of tumor plasma cells<\/strong>.<\/p>\n<p>Radiotherapy may also be used with <strong>curative intent<\/strong>, typically at higher doses, in the treatment of <strong>solitary plasmacytoma<\/strong>.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Supportive Therapy With Bisphosphonates<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p class=\"isSelectedEnd\">Patients with newly diagnosed <strong>multiple myeloma<\/strong> may receive treatment with <strong>zoledronic acid<\/strong>, administered as a <strong>monthly intravenous infusion<\/strong>, typically for at least <strong>one year<\/strong> and up to <strong>two years<\/strong> after the start of therapy.<\/p>\n<p class=\"isSelectedEnd\">This treatment helps <strong>strengthen bones affected by osteolytic lesions<\/strong> and reduces the risk of <strong>pathological fractures<\/strong>.<\/p>\n<p class=\"isSelectedEnd\">Before starting zoledronic acid, patients should undergo an assessment of <strong>kidney function<\/strong> and a <strong>dental evaluation<\/strong> to identify any untreated dental disease or active oral infections.<\/p>\n<p>These conditions may increase the risk of <strong>osteonecrosis of the jaw<\/strong>, a rare but important side effect associated with bisphosphonate therapy.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\n\t<\/div>\n\n\n\n<p class=\"wp-block-paragraph\">The choice of treatment is based on several factors, including the patient\u2019s <strong>age, overall health, comorbidities, and medical history<\/strong>. The proposed treatment plan is discussed with the patient, and when multiple options offer comparable effectiveness, the available alternatives are presented to support <strong>shared decision-making<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">For patients who are <strong>younger and medically fit<\/strong>, treatment generally consists of a more intensive approach combining <strong>immunotherapy, immunomodulatory agents, and proteasome inhibitors<\/strong>, followed by <strong>high-dose chemotherapy and autologous stem cell transplantation<\/strong>. This is typically followed by <strong>maintenance therapy<\/strong> to help maintain disease control.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">For <strong>older patients<\/strong> or those with significant comorbidities, treatment usually involves combinations of <strong>biologic agents and\/or immunotherapies<\/strong> with a more favorable safety profile. These regimens aim to achieve effective disease control while preserving <strong>quality of life<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">For selected patients with <strong>high-risk or particularly aggressive disease<\/strong>, especially when standard treatments have not achieved the desired results, participation in <strong><a href=\"https:\/\/inoc.it\/en\/medical-area\/clinical-research-unit-cru\/\">clinical trials<\/a><\/strong> may be considered. If deemed appropriate by the <strong>GIC<\/strong>, this option will be discussed in detail with the patient, and any decision will be made through a <strong>shared and informed process<\/strong>.<\/p>\n\n\n\t<div id=\"block_6a3a5cd1f33c2\" class=\"accordion-block acf-block\">\n\t\t<div class=\"my-4 lg:my-6\">\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Patients Eligible for Autologous Stem Cell Transplantation<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p class=\"isSelectedEnd\">Treatment for patients eligible for <strong>autologous stem cell transplantation<\/strong> consists of several phases and combines different therapies to achieve the maximum possible reduction of myeloma cells.<\/p>\n<p>&nbsp;<\/p>\n<h3><strong>Induction Therapy<\/strong><\/h3>\n<p class=\"isSelectedEnd\">The first phase, known as <strong>induction therapy<\/strong>, involves the administration of <strong>three or four biologic and immunotherapeutic agents<\/strong> with the aim of rapidly reducing the tumor burden.<\/p>\n<p class=\"isSelectedEnd\">When clinically appropriate, treatment can be delivered in a <strong>day hospital setting<\/strong>, with medications administered <strong>subcutaneously or intravenously<\/strong> by nursing staff, while oral therapies are taken at home.<\/p>\n<p class=\"isSelectedEnd\">One of the most commonly used induction regimens combines <strong>daratumumab<\/strong>, <strong>bortezomib<\/strong>, <strong>thalidomide<\/strong>, and <strong>corticosteroids<\/strong>, administered over <strong>four 28-day cycles<\/strong>.<\/p>\n<p>&nbsp;<\/p>\n<h3><strong>Stem Cell Collection<\/strong><\/h3>\n<p class=\"isSelectedEnd\">Following induction therapy, <strong>hematopoietic stem cells<\/strong> are collected from the patient. These cells are the precursors of all blood cell types and are harvested through a procedure called <strong>stem cell apheresis<\/strong>.<\/p>\n<p class=\"isSelectedEnd\">Stem cell collection is a <strong>non-invasive procedure<\/strong>, similar to an extended blood donation, and can be performed on an <strong>outpatient basis<\/strong> or during a short hospital stay.<\/p>\n<p>&nbsp;<\/p>\n<h3><strong>Autologous Stem Cell Transplantation<\/strong><\/h3>\n<p class=\"isSelectedEnd\">After stem cell collection, patients are admitted to hospital for <strong>autologous stem cell transplantation<\/strong>.<\/p>\n<p class=\"isSelectedEnd\">During hospitalization, <strong>high-dose chemotherapy with melphalan<\/strong> is administered to eliminate any remaining myeloma cells. The previously collected stem cells are then reinfused through a procedure similar to a blood transfusion, allowing the bone marrow to recover more rapidly and restore the production of <strong>red blood cells, white blood cells, and platelets<\/strong>.<\/p>\n<p>&nbsp;<\/p>\n<h3><strong>Consolidation and Maintenance Therapy<\/strong><\/h3>\n<p class=\"isSelectedEnd\">Following recovery from transplantation, patients may receive <strong>two cycles of consolidation therapy<\/strong>, using regimens similar to those administered during induction, to further strengthen the treatment response.<\/p>\n<p class=\"isSelectedEnd\">This is followed by <strong>maintenance therapy<\/strong>, usually consisting of an oral non-chemotherapy biologic agent taken at home, with the aim of prolonging <strong>disease remission<\/strong>.<\/p>\n<p>During this phase, patients undergo regular follow-up visits, initially at shorter intervals and then progressively less frequently, to monitor both <strong>disease status<\/strong> and <strong>overall clinical condition<\/strong>.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Patients Not Eligible for Autologous Stem Cell Transplantation<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p class=\"isSelectedEnd\">Patients who are not eligible for <strong>autologous stem cell transplantation<\/strong> are typically treated with combinations of <strong>two or three immunotherapy and biologic agents<\/strong>, administered on an <strong>outpatient basis<\/strong> by specialized nursing staff.<\/p>\n<p class=\"isSelectedEnd\">The choice of treatment is not based on <strong>age alone<\/strong>. Other important factors are carefully evaluated, including the presence of <strong>comorbidities<\/strong>, the patient\u2019s <strong>functional status and level of independence<\/strong>, and the availability of <strong>caregiver support<\/strong>.<\/p>\n<p>All treatment options are discussed with the patient, taking into account their <strong>individual preferences, needs, and treatment goals<\/strong>, to ensure a personalized and shared decision-making process.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Patients With Relapsed Multiple Myeloma<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p class=\"isSelectedEnd\"><strong>Multiple myeloma<\/strong> is often managed as a <strong>chronic disease<\/strong>, characterized by periods of <strong>remission<\/strong> alternating with phases of <strong>relapse<\/strong> that may require additional treatment.<\/p>\n<p class=\"isSelectedEnd\">Fortunately, several effective therapeutic options are available for patients with relapsed disease. Treatment generally consists of combinations of <strong>immunotherapies and biologic agents<\/strong>, often different from those used at the time of diagnosis, in order to target myeloma cells through different biological mechanisms.<\/p>\n<p><strong>Chemotherapy<\/strong> plays a more limited role in the treatment of relapsed multiple myeloma and is used less frequently than in the past, as newer targeted and immunotherapeutic approaches have become available.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\n\t<\/div>\n\n\n\n<h3 class=\"wp-block-heading\">Treatment of Other Plasma Cell Disorders<\/h3>\n\n\n\t<div id=\"block_6a3a5cd1f3405\" class=\"accordion-block acf-block\">\n\t\t<div class=\"my-4 lg:my-6\">\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Asymptomatic Multiple Myeloma<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p class=\"isSelectedEnd\">In some patients, <strong>tumor plasma cells<\/strong> are present without the typical signs or symptoms of multiple myeloma.<\/p>\n<p class=\"isSelectedEnd\">This condition is known as <strong>asymptomatic<\/strong> or <strong>smoldering multiple myeloma<\/strong> and does not require immediate treatment. Instead, patients undergo <strong>regular monitoring<\/strong>, including assessment of the <strong>monoclonal component<\/strong>, laboratory tests every <strong>3 to 6 months<\/strong>, and <strong>MRI examinations<\/strong>, usually at least once a year.<\/p>\n<p class=\"isSelectedEnd\">Smoldering multiple myeloma carries a risk of progression to <strong>symptomatic multiple myeloma<\/strong>. The level of risk depends on several <strong>clinical and biological factors<\/strong>, which are used to determine the frequency of follow-up evaluations.<\/p>\n<p class=\"isSelectedEnd\">The aim of monitoring is to detect disease progression at an early stage, before significant organ damage or other complications develop.<\/p>\n<p>It is important to note that some patients with <strong>smoldering multiple myeloma<\/strong> may never develop symptoms and can continue with observation alone, with follow-up intervals gradually extended over time.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Solitary Plasmacytoma<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p class=\"isSelectedEnd\">The <strong>treatment of choice<\/strong> for <strong>solitary plasmacytoma<\/strong> is <strong>radiotherapy<\/strong>.<\/p>\n<p class=\"isSelectedEnd\">Radiotherapy is typically delivered in <strong>daily sessions, Monday through Friday<\/strong>, over several weeks, depending on the prescribed radiation dose. Each treatment session generally lasts only a <strong>few minutes<\/strong>.<\/p>\n<p>The goal of radiotherapy is to achieve <strong>local disease control<\/strong> and, in many cases, long-term remission.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Amyloidosis<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p class=\"isSelectedEnd\">Many of the drugs used to treat <strong>amyloidosis<\/strong> are the same as those employed in the treatment of <strong>multiple myeloma<\/strong>.<\/p>\n<p class=\"isSelectedEnd\">The type, dose, and intensity of therapy are carefully tailored according to the <strong>organs affected by amyloid deposits<\/strong> and the patient&#8217;s overall clinical condition.<\/p>\n<p>Management of amyloidosis requires a <strong>multidisciplinary approach<\/strong> and may involve specialists from different fields, including <strong>nephrology, cardiology, and gastroenterology<\/strong>, depending on the sites of organ involvement.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\n\t<\/div>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"ongoing-support\" class=\"h2_anchor\"><\/span>Ongoing Support<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">At <strong>INOC \u2013 Istituto Nazionale Oncologico Candiolo<\/strong>, we provide continuous support before, during, and after treatment, accompanying each patient throughout the entire course of care and recovery.<\/p>\n\n\n\t<div id=\"block_6a3a5cd1f3c97\" class=\"accordion-block acf-block\">\n\t\t<div class=\"my-4 lg:my-6\">\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Management of Side Effects<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p class=\"isSelectedEnd\">Treatment for <strong>multiple myeloma<\/strong> may be associated with side effects that can affect <strong>quality of life<\/strong> to varying degrees. However, many of these effects can be <strong>managed effectively<\/strong> and, in some cases, <strong>prevented<\/strong> through appropriate supportive treatments and lifestyle measures.<\/p>\n<p>At <strong>INOC &#8211; Istituto Nazionale Oncologico Candiolo<\/strong>, physicians and nurses within the <strong>GIC<\/strong> provide continuous support to help patients manage any side effects that may arise during treatment. The goal is to ensure that each patient receives comprehensive care throughout every stage of the therapeutic pathway.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Direct Access to Specialists<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p class=\"isSelectedEnd\">To ensure timely support and provide prompt answers to questions or concerns, <strong>INOC &#8211; Istituto Nazionale Oncologico Candiolo<\/strong>\u00a0offers a dedicated assistance service for all patients.<\/p>\n<p class=\"isSelectedEnd\">From\u00a0<strong>Monday through Friday<\/strong>, between\u00a0<strong>8:00 a.m. and 5:00 p.m.<\/strong>, patients can contact the\u00a0<a href=\"https:\/\/inoc.it\/en\/medical-area\/oncology-day-hospital\/\">Oncology Day Hospital<\/a>\u00a0Secretariat at\u00a0<strong>+39 011 993 3775<\/strong>\u00a0to request an urgent consultation.<\/p>\n<p>Patients are promptly connected with their specialist physician, ensuring rapid access to expert advice, clear information, and immediate support when needed.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Supportive and Palliative Care<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p class=\"isSelectedEnd\">Cancer patients often have\u00a0<strong>complex needs<\/strong>\u00a0that extend beyond the treatment of the disease itself and require comprehensive,<strong>\u00a0multidisciplinary care.<\/strong><\/p>\n<p class=\"isSelectedEnd\">At <strong>INOC &#8211; Istituto Nazionale Oncologico Candiolo<\/strong>, patients who need additional support have access to specialists from a range of disciplines, ensuring personalized management of cancer-related symptoms and associated conditions. Services may include nutritional counseling, physical rehabilitation, pain management, and support for other medical needs that may arise during the course of treatment and recovery.<\/p>\n<p>The goal is to\u00a0<strong>improve quality of life, promote overall well-being, and provide comprehensive care<\/strong>\u00a0tailored to each patient\u2019s individual needs.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Social Work Services<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p data-start=\"26\" data-end=\"278\">The Social Work Service at INOC &#8211; Istituto Nazionale Oncologico Candiolo provides\u00a0<strong>information, guidance, and support to patients and their families<\/strong>\u00a0regarding access to community services and the welfare and social security benefits available under current legislation.<\/p>\n<p data-start=\"280\" data-end=\"491\">During dedicated consultations, social workers assist with matters such as disability recognition, access to aids and prosthetic devices, employment-related benefits and leave, and other social support services.<\/p>\n<p data-start=\"493\" data-end=\"621\" data-is-last-node=\"\" data-is-only-node=\"\">The service is available on\u00a0<strong data-start=\"521\" data-end=\"575\">Wednesdays and Fridays from 9:00 a.m. to 1:00 p.m.<\/strong>\u00a0and can be contacted at\u00a0<strong data-start=\"600\" data-end=\"620\">+39 011 993 3059<\/strong>.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Follow-up<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p class=\"isSelectedEnd\">Response to treatment is primarily assessed by measuring the <strong>monoclonal component in blood and\/or urine<\/strong>, typically at every treatment cycle or every <strong>2 to 3 cycles<\/strong>. When treatment is effective, the monoclonal component progressively decreases and may eventually become <strong>undetectable<\/strong>.<\/p>\n<p class=\"isSelectedEnd\">When the monoclonal component disappears or is reduced by more than <strong>90%<\/strong>, the physician may request a repeat <strong>bone marrow aspiration<\/strong> to evaluate the reduction, or in the best cases, the disappearance of <strong>tumor plasma cells<\/strong> from the bone marrow. Although this assessment is not routinely required in clinical practice, it can provide valuable information regarding <strong>minimal residual disease<\/strong> and prognosis.<\/p>\n<p class=\"isSelectedEnd\">Treatment response is also monitored through<a href=\"https:\/\/inoc.it\/en\/medical-area\/radiodiagnostics\/\"> <strong>imaging studies<\/strong><\/a>, usually using the same technique performed at diagnosis, such as:<\/p>\n<ul data-spread=\"false\">\n<li><strong>Whole-body low-dose CT<\/strong><\/li>\n<li><strong>PET-CT<\/strong><\/li>\n<li><strong>MRI<\/strong><\/li>\n<\/ul>\n<p class=\"isSelectedEnd\">The timing of these examinations is determined by the physician according to the patient&#8217;s clinical situation and treatment course.<\/p>\n<p class=\"isSelectedEnd\">Most therapies for <strong>multiple myeloma<\/strong> are administered on a <strong>continuous basis<\/strong> and are maintained until disease progression or the development of unacceptable treatment-related toxicity.<\/p>\n<p class=\"isSelectedEnd\">In the event of <strong>disease relapse<\/strong>, which is often identified by an increase in the monoclonal component with or without the recurrence of symptoms, the physician may request a new <strong>bone marrow biopsy and aspiration<\/strong> to reassess the burden of tumor plasma cells and evaluate bone marrow function.<\/p>\n<p>Additional <strong>imaging studies<\/strong> may also be performed to identify any new <strong>osteolytic lesions<\/strong> or other signs of disease progression.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\n\t<\/div>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"multi-disciplinary-team\" class=\"h2_anchor\"><\/span>Multi Disciplinary Team<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Every cancer requires a&nbsp;<strong>multidisciplinary approach<\/strong>&nbsp;at all stages of disease management. At INOC &#8211; Istituto Nazionale Oncologico Candiolo, this is provided by a team of specialists from various clinical and surgical departments, known as the&nbsp;<strong>GIC<\/strong>, Interdisciplinary Care Group (or MDT). The GIC ensures that each patient is supported throughout the diagnostic and therapeutic process, including arranging and coordinating examinations and maintaining communication with the patient and their family.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">For each patient, the GIC (MDT) defines and shares a personalized care pathway based not only on the type and stage of the tumor but also on the patient\u2019s individual characteristics. The goal is to achieve the best possible outcomes both oncologically and functionally, while maintaining a high quality of life.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"clinical-divisions\" class=\"h2_anchor\"><\/span>Clinical Divisions<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The diagnostic-therapeutic pathway for<strong> INOC \u2013 Istituto Nazionale Oncologico Candiolo<\/strong> myelomas involves several clinical divisions, including:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/inoc.it\/en\/medical-area\/medical-oncology\/\" type=\"medical-area\" id=\"5169\">Medical Oncology<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/inoc.it\/en\/medical-area\/hemopoietic-stem-cell-transplantation-and-cellular-therapies-center\/\" type=\"medical-area\" id=\"5191\">Hemopoietic Stem Cell Transplantation and Cellular Therapies Center<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/inoc.it\/en\/medical-area\/oncology-day-hospital\/\" type=\"medical-area\" id=\"5183\">Day Hospital<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/inoc.it\/en\/medical-area\/radiotherapy\/\" type=\"medical-area\" id=\"5104\">Radiotherapy<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/inoc.it\/en\/medical-area\/laboratory-analysis\/\" type=\"medical-area\" id=\"5113\">Laboratory Analysis<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/inoc.it\/en\/medical-area\/pathologic-anatomy\/\" type=\"medical-area\" id=\"5118\">Anatomical Pathology<\/a><\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"clinical-studies\" class=\"h2_anchor\"><\/span>Clinical Studies<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Researchers at <strong>INOC &#8211; Istituto Nazionale Oncologico Candiolo<\/strong> are actively involved in numerous <strong>national and international research projects<\/strong> dedicated to <strong>multiple myeloma<\/strong>. These initiatives include both <strong>laboratory research<\/strong> and <strong>clinical trials<\/strong> evaluating innovative therapies that are not yet available in routine clinical practice, helping to expand treatment opportunities for patients.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">In selected cases, patients may also be eligible to participate in <strong><a href=\"https:\/\/inoc.it\/en\/medical-area\/clinical-research-unit-cru\/\">clinical trials<\/a><\/strong> designed to assess the <strong>safety and efficacy of new drugs and innovative therapeutic approaches<\/strong>. Participation in these studies may provide access to <strong>cutting-edge treatments<\/strong>, always under <strong>close medical supervision<\/strong> and within a highly specialized clinical setting.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"why-choose-us\" class=\"h2_anchor\"><\/span>Why Choose Us<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">At INOC &#8211; Istituto Nazionale Oncologico Candiolo, acute leukemia patients are treated in a&nbsp;<strong>highly specialized<\/strong>&nbsp;manner, thanks to the synergistic work of the dedicated<a href=\"https:\/\/inoc.it\/en\/pathology\/melanomas\/#multi-disciplinary-team\">&nbsp;<\/a><a href=\"https:\/\/inoc.it\/en\/pathology\/myelomas\/#multi-disciplinary-team\">Interdisciplinary Care Group (GIC)&nbsp;.<\/a><\/p>\n\n\n\t<div id=\"block_6a3a5cd1f3cee\" class=\"accordion-block acf-block\">\n\t\t<div class=\"my-4 lg:my-6\">\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Clinical Experience and Tailored Approach<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p>Thanks to the large number of cases treated each year, INOC &#8211; Istituto Nazionale Oncologico Candiolo is a\u00a0<strong>national reference<\/strong>\u00a0center for the care of this disease. This extensive experience allows us to manage even the most complex cases, always using a\u00a0<strong>personalized approach<\/strong>, tailored to the clinical and individual profile of each patient.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Imaging Technologies and Advanced Diagnostics<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p>Establishing a treatment plan always begins with an accurate and timely diagnosis. Patients have access to\u00a0<strong>state-of-the-art imaging technologies<\/strong>, such as ultrasound, contrast-enhanced CT, MRI, and cholangio-RM, which are critical for accurately assessing the extent of the tumor.<\/p>\n<p><strong>Advanced laboratory tests<\/strong>, including molecular analyses, are also available to help define biological features of the disease and guide treatment choices.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Clinical Research and Access to Trials<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<h3 class=\"wp-block-heading\"><\/h3>\n<p><!-- \/wp:heading --><\/p>\n<p>As an IRCCS (Scientific Institute for Research, Hospitalization, and Healthcare), INOC &#8211; Istituto Nazionale Oncologico Candiolo combines clinical care with a strong focus on scientific research. Patients can be considered for\u00a0<a href=\"https:\/\/inoc.it\/en\/pathology\/myelomas\/#clinical-studies\"><strong>participation in active clinical trials<\/strong><\/a>, offering access to innovative therapies not yet available in standard practice. This integration of care and research is a distinctive strength that translates into tangible benefits for patients.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Care and Support Every Step of the Way<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p><a href=\"https:\/\/inoc.it\/en\/pathology\/myelomas\/#multi-disciplinary-team\">The Interdisciplinary Care Group\u00a0<\/a>(GIC or MDT)\u00a0<strong>supports th<\/strong><strong>e patient at every stage<\/strong>: from diagnosis, through treatment, to follow-up. Special attention is paid to<strong>\u00a0nutritional support, psychological health and reintegration into daily life.<\/strong>\u00a0The organization of checkups, examinations, and treatment is designed to ensure\u00a0<strong>continuity, serenity, and a humane, caring<\/strong>\u00a0approach to each patient\u2019s needs.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\n\t<\/div>\n","protected":false},"featured_media":0,"template":"","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"class_list":["post-5220","pathology","type-pathology","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - 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