International myeloma working group recommendations for the treatment of multiple myeloma-related bone disease

Evangelos Terpos, Gareth Morgan, Meletios A. Dimopoulos, Matthew T. Drake, Suzanne Lentzsch, Noopur Raje, Orhan Sezer, Ramón García-Sanz, Kazuyuki Shimizu, Ingemar Turesson, Tony Reiman, Artur Jurczyszyn, Giampaolo Merlini, Andrew Spencer, Xavier Leleu, Michele Cavo, Nikhil Munshi, S. Vincent Rajkumar, Brian G.M. Durie, G. David Roodman

Research output: Contribution to journalArticlepeer-review

231 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)2347-2357
Number of pages11
JournalJournal of Clinical Oncology
Issue number18
StatePublished - Jun 20 2013

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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