International Myeloma Working Group recommendations for the treatment of multiple myeloma-related bone disease.
Date
2013-06ICR Author
Author
Terpos, E
Morgan, G
Dimopoulos, MA
Drake, MT
Lentzsch, S
Raje, N
Sezer, O
García-Sanz, R
Shimizu, K
Turesson, I
Reiman, T
Jurczyszyn, A
Merlini, G
Spencer, A
Leleu, X
Cavo, M
Munshi, N
Rajkumar, SV
Durie, BGM
Roodman, GD
Type
Journal Article
Metadata
Show full item recordAbstract
Purpose The aim of the International Myeloma Working Group was to develop practice recommendations for the management of multiple myeloma (MM) -related bone disease.Methodology An interdisciplinary panel of clinical experts on MM and myeloma bone disease developed recommendations based on published data through August 2012. Expert consensus was used to propose additional recommendations in situations where there were insufficient published data. Levels of evidence and grades of recommendations were assigned and approved by panel members.Recommendations Bisphosphonates (BPs) should be considered in all patients with MM receiving first-line antimyeloma therapy, regardless of presence of osteolytic bone lesions on conventional radiography. However, it is unknown if BPs offer any advantage in patients with no bone disease assessed by magnetic resonance imaging or positron emission tomography/computed tomography. Intravenous (IV) zoledronic acid (ZOL) or pamidronate (PAM) is recommended for preventing skeletal-related events in patients with MM. ZOL is preferred over oral clodronate in newly diagnosed patients with MM because of its potential antimyeloma effects and survival benefits. BPs should be administered every 3 to 4 weeks IV during initial therapy. ZOL or PAM should be continued in patients with active disease and should be resumed after disease relapse, if discontinued in patients achieving complete or very good partial response. BPs are well tolerated, but preventive strategies must be instituted to avoid renal toxicity or osteonecrosis of the jaw. Kyphoplasty should be considered for symptomatic vertebral compression fractures. Low-dose radiation therapy can be used for palliation of uncontrolled pain, impending pathologic fracture, or spinal cord compression. Orthopedic consultation should be sought for long-bone fractures, spinal cord compression, and vertebral column instability.
Collections
Subject
Humans
Multiple Myeloma
Bone Diseases
Osteonecrosis
Diphosphonates
Clodronic Acid
Imidazoles
Positron-Emission Tomography
Tomography, X-Ray Computed
Magnetic Resonance Imaging
Combined Modality Therapy
Drug Therapy, Combination
Radiotherapy
Medical Oncology
International Cooperation
Bone Density Conservation Agents
Fractures, Bone
Practice Guidelines as Topic
Administration, Intravenous
Zoledronic Acid
Pamidronate
Outcome Assessment, Health Care
Research team
Molecular Haematology (including Cytogenetics Group and Cell Markers)
Language
eng
License start date
2013-06
Citation
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2013, 31 (18), pp. 2347 - 2357