TY - JOUR
T1 - Treatment of multiple myeloma-related bone disease
T2 - recommendations from the Bone Working Group of the International Myeloma Working Group
AU - Bone Working Group of the International Myeloma Working Group
AU - Terpos, Evangelos
AU - Zamagni, Elena
AU - Lentzsch, Suzanne
AU - Drake, Matthew T.
AU - García-Sanz, Ramón
AU - Abildgaard, Niels
AU - Ntanasis-Stathopoulos, Ioannis
AU - Schjesvold, Fredrik
AU - de la Rubia, Javier
AU - Kyriakou, Charalampia
AU - Hillengass, Jens
AU - Zweegman, Sonja
AU - Cavo, Michele
AU - Moreau, Philippe
AU - San-Miguel, Jesus
AU - Dimopoulos, Meletios A.
AU - Munshi, Nikhil
AU - Durie, Brian G.M.
AU - Raje, Noopur
N1 - Publisher Copyright:
© 2021 Elsevier Ltd
PY - 2021/3
Y1 - 2021/3
N2 - In this Policy Review, the Bone Working Group of the International Myeloma Working Group updates its clinical practice recommendations for the management of multiple myeloma-related bone disease. After assessing the available literature and grading recommendations using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) method, experts from the working group recommend zoledronic acid as the preferred bone-targeted agent for patients with newly diagnosed multiple myeloma, with or without multiple myeloma-related bone disease. Once patients achieve a very good partial response or better, after receiving monthly zoledronic acid for at least 12 months, the treating physician can consider decreasing the frequency of or discontinuing zoledronic acid treatment. Denosumab can also be considered for the treatment of multiple myeloma-related bone disease, particularly in patients with renal impairment. Denosumab might prolong progression-free survival in patients with newly diagnosed multiple myeloma who have multiple myeloma-related bone disease and who are eligible for autologous stem-cell transplantation. Denosumab discontinuation is challenging due to the rebound effect. The Bone Working Group of the International Myeloma Working Group also found cement augmentation to be effective for painful vertebral compression fractures. Radiotherapy is recommended for uncontrolled pain, impeding or symptomatic spinal cord compression, or pathological fractures. Surgery should be used for the prevention and restoration of long-bone pathological fractures, vertebral column instability, and spinal cord compression with bone fragments within the spinal route.
AB - In this Policy Review, the Bone Working Group of the International Myeloma Working Group updates its clinical practice recommendations for the management of multiple myeloma-related bone disease. After assessing the available literature and grading recommendations using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) method, experts from the working group recommend zoledronic acid as the preferred bone-targeted agent for patients with newly diagnosed multiple myeloma, with or without multiple myeloma-related bone disease. Once patients achieve a very good partial response or better, after receiving monthly zoledronic acid for at least 12 months, the treating physician can consider decreasing the frequency of or discontinuing zoledronic acid treatment. Denosumab can also be considered for the treatment of multiple myeloma-related bone disease, particularly in patients with renal impairment. Denosumab might prolong progression-free survival in patients with newly diagnosed multiple myeloma who have multiple myeloma-related bone disease and who are eligible for autologous stem-cell transplantation. Denosumab discontinuation is challenging due to the rebound effect. The Bone Working Group of the International Myeloma Working Group also found cement augmentation to be effective for painful vertebral compression fractures. Radiotherapy is recommended for uncontrolled pain, impeding or symptomatic spinal cord compression, or pathological fractures. Surgery should be used for the prevention and restoration of long-bone pathological fractures, vertebral column instability, and spinal cord compression with bone fragments within the spinal route.
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U2 - 10.1016/S1470-2045(20)30559-3
DO - 10.1016/S1470-2045(20)30559-3
M3 - Review article
C2 - 33545067
AN - SCOPUS:85101284824
SN - 1470-2045
VL - 22
SP - e119-e130
JO - The Lancet Oncology
JF - The Lancet Oncology
IS - 3
ER -