International Myeloma Working Group recommendations for the treatment of multiple myeloma-related bone disease

TY - JOUR

T1 - International Myeloma Working Group recommendations for the treatment of multiple myeloma-related bone disease

AU - Terpos, Evangelos

AU - Morgan, Gareth

AU - Dimopoulos, Meletios A

AU - Drake, Matthew T

AU - Lentzsch, Suzanne

AU - Raje, Noopur

AU - Sezer, Orhan

AU - García-Sanz, Ramón

AU - Shimizu, Kazuyuki

AU - Turesson, Ingemar

AU - Reiman, Tony

AU - Jurczyszyn, Artur

AU - Merlini, Giampaolo

AU - Spencer, Andrew

AU - Leleu, Xavier

AU - Cavo, Michele

AU - Munshi, Nikhil

AU - Rajkumar, S Vincent

AU - Durie, Brian G M

AU - Roodman, G David

PY - 2013/6/20

Y1 - 2013/6/20

N2 - 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.

AB - 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.

KW - Administration, Intravenous

KW - Bone Density Conservation Agents

KW - Bone Diseases

KW - Clodronic Acid

KW - Combined Modality Therapy

KW - Diphosphonates

KW - Drug Therapy, Combination

KW - Fractures, Bone

KW - Humans

KW - Imidazoles

KW - International Cooperation

KW - Magnetic Resonance Imaging

KW - Medical Oncology

KW - Multiple Myeloma

KW - Osteonecrosis

KW - Outcome Assessment (Health Care)

KW - Positron-Emission Tomography

KW - Practice Guidelines as Topic

KW - Radiotherapy

KW - Tomography, X-Ray Computed

U2 - 10.1200/JCO.2012.47.7901

DO - 10.1200/JCO.2012.47.7901

M3 - SCORING: Journal article

C2 - 23690408

VL - 31

SP - 2347

EP - 2357

JO - J CLIN ONCOL

JF - J CLIN ONCOL

SN - 0732-183X

IS - 18

ER -