Increasing Bone Sclerosis During Bortezomib Therapy in Multiple Myeloma Patients: Results of a Reduced-Dose Whole-Body MDCT Study
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.
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).
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.
Available from: Bronek Boszczyk
- "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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ABSTRACT: Myeloma is one of the most common malignancies that results in osteolytic lesions of the spine. Complications, including pathological fractures of the vertebrae and spinal cord compression, may cause severe pain, deformity and neurological sequelae. They may also have significant consequences for quality of life and prognosis for patients. For patients with known or newly diagnosed myeloma presenting with persistent back or radicular pain/weakness, early diagnosis of spinal myeloma disease is therefore essential to treat and prevent further deterioration. Magnetic resonance imaging is the initial imaging modality of choice for the evaluation of spinal disease. Treatment of the underlying malignancy with systemic chemotherapy together with supportive bisphosphonate treatment reduces further vertebral damage. Additional interventions such as cement augmentation, radiotherapy, or surgery are often necessary to prevent, treat and control spinal complications. However, optimal management is dependent on the individual nature of the spinal involvement and requires careful assessment and appropriate intervention throughout. This article reviews the treatment and management options for spinal myeloma disease and highlights the value of defined pathways to enable the proper management of patients affected by it.
© 2015 John Wiley & Sons Ltd.
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ABSTRACT: Multiple myeloma is a disseminated neoplastic monoclonal gammopathy that usually affects the skull, clavicle, rib, pelvis, spinal column, and proximal portions of the humerus and femur. The initial manifestation of multiple myeloma in the sternum is rare. The classic radiological presentations of multiple myeloma are multiple "punched-out" areas of bone destruction, expansile lytic lesions, and generalized osteoporosis. Primary sclerotic presentation is rare and occurs in only 3 % of cases. A sclerotic multiple myeloma with a sunburst periosteal reaction occurring in the sternum has not been reported in the English literature. We report a case of sclerotic multiple myeloma of a 49-year-old woman. In the sternum, the lesion displayed extensive sclerosis mixed with mottled lytic areas with a sunburst periosteal reaction occurring in the periphery, which radiologically mimicked an osteosarcoma. Multiple focal areas of sclerosis were also found in the right clavicle, pelvis, multiple ribs, and vertebrae.
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ABSTRACT: The identification of bone lesions and extramedullary disease is crucial in the diagnosis of myeloma. Whole-body X-ray (WBXR) is considered the gold standard for the detection of myeloma bone lesions. Nevertheless, the International Myeloma Working Group recently updated the disease definition and emphasised the value of magnetic resonance imaging (MRI), computed tomography (CT) alone or combined with 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET). The presence of more than one focal lesion with MRI or the presence of one or more lytic bone lesion with CT (including low dose CT alone or combined with FDG PET) is considered as myeloma defining events (if 5 mm or more in size). Due to its higher sensitivity to detect bone lesions (in comparison with WBXR), MRI of spine and pelvis is mandatory for patients with solitary plasmacytoma as additional bone lesions can be detected in approximately one-third of cases. MRI is also recommended in patients with smouldering myeloma and may be considered for the staging of multiple myeloma (MM). Moreover, accurate imaging of MM and related plasma cell disorders using MRI and/or FDG PET/CT may provide information on tumour burden, aggressiveness and tumour heterogeneity. Nonetheless, inclusion of MRI and FDG PET/CT for MM patient stratification and therapeutic decisions remains to define.
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