Article

Increasing Bone Sclerosis During Bortezomib Therapy in Multiple Myeloma Patients: Results of a Reduced-Dose Whole-Body MDCT Study

American Journal of Roentgenology (Impact Factor: 2.74). 01/2014; 202(1):170-9. DOI: 10.2214/AJR.12.10367
Source: PubMed

ABSTRACT OBJECTIVE. The objective of our study was to assess the frequency, location, extent, and patterns of bone sclerosis occurring in patients with multiple myeloma (MM) during bortezomib-based therapy. MATERIALS AND METHODS. From June 2003 through December 2011, 593 whole-body reduced-dose MDCT studies were performed of 79 consecutive patients receiving bortezomib. The median surveillance time was 21 months (range, 3-67 months). Baseline studies were compared with follow-up studies during therapy (follow-up 1), at the end of therapy (follow-up 2), and 12 months after cessation of bortezomib therapy (follow-up 3). We recorded any sclerotic change occurring inside or along the margins of the osteolytic lesions, in the cancellous bone, or inside preexistent medullary or extramedullary lesions. The time point of occurrence of bone sclerosis was correlated with the best hematologic response category. RESULTS. Fourteen (17.7%) patients developed focal (n = 11) or diffuse (n = 3) bone sclerosis. The time window from bortezomib initiation to radiographic detection of bone sclerosis was 8 months (SD, 7 months). Sclerosis occurred at multiple sites (n = 7) or at an isolated site (n = 7). On subsequent whole-body reduced-dose MDCT studies, sclerosis further increased in seven (50%) patients. Hematologic best response during bortezomib treatment was complete response (n = 1), very good partial response (n = 2), partial response (n = 8), and stable disease (n = 3). Radiologic response at the time of sclerosis detection was partial response (n = 8), stable disease (n = 2), and progressive disease (n = 4). CONCLUSION. Bone remineralization may occur during bortezomib-based therapy for MM in a substantial proportion of patients. The extent, location, and patterns of sclerosis differ among patients and are unpredictable. Sclerosis was documented even in patients showing suboptimal hematologic response.

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    • "That said; it is possible that patients may respond with reduction in their myeloma monoclonal protein but still have persistent pain, in which case local approaches to manage pain are more appropriate than switching systemic therapy. Bortezomib has been linked to increased osteoblastic activity and bone formation (De Matteo et al, 2010; Terpos, 2010), with several studies reporting a positive effect on bone health in patients on the drug, including an improvement in osteolytic lesions (Delforge et al, 2011; Lee et al, 2011; Schulze et al, 2014). Therefore, a switch to bortezomib may prove more effective for targeting extensive bone disease. "
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