Publicaciones científicas

Treatment of multiple myeloma-related bone disease: recommendations from the Bone Working Group of the International Myeloma Working Group

01-mar-2021 | Revista: The Lancet. Oncology

Evangelos Terpos  1 , Elena Zamagni  2 , Suzanne Lentzsch  3 , Matthew T Drake  4 , Ramón García-Sanz  5 , Niels Abildgaard  6 , Ioannis Ntanasis-Stathopoulos  7 , Fredrik Schjesvold  8 , Javier de la Rubia  9 , Charalampia Kyriakou  10 , Jens Hillengass  11 , Sonja Zweegman  12 , Michele Cavo  2 , Philippe Moreau  13 , Jesus San-Miguel  14 , Meletios A Dimopoulos  7 , Nikhil Munshi  15 , Brian G M Durie  16 , Noopur Raje  17 , Bone Working Group of the International Myeloma Working Group


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.

CITA DEL ARTÍCULO  Lancet Oncol. 2021 Mar;22(3):e119-e130.  doi: 10.1016/S1470-2045(20)30559-3. Epub 2021 Feb 2.