International Myeloma Working Group recommendations for the treatment of multiple myeloma-related bone disease
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International Myeloma Working Group recommendations for the treatment of multiple myeloma-related bone disease. / Terpos, Evangelos; Morgan, Gareth; Dimopoulos, Meletios A; Drake, Matthew T; Lentzsch, Suzanne; Raje, Noopur; Sezer, Orhan; García-Sanz, Ramón; Shimizu, Kazuyuki; Turesson, Ingemar; Reiman, Tony; Jurczyszyn, Artur; Merlini, Giampaolo; Spencer, Andrew; Leleu, Xavier; Cavo, Michele; Munshi, Nikhil; Rajkumar, S Vincent; Durie, Brian G M; Roodman, G David.
In: J CLIN ONCOL, Vol. 31, No. 18, 20.06.2013, p. 2347-57.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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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 -