The International Myeloma Working Group (IMWG) has developed clinical practice recommendations for the management of multiple myeloma-related bone disease based on published study data through August 2012. Consensus of the interdisciplinary panel of clinical experts on the plasma cell cancer was used to propose additional guidelines in situations in which there were insufficient published data. The recommendations were recently published in the Journal of Clinical Oncology (JCO).1
Included in the recommendations is the use of bisphosphonates for all multiple myeloma patients receiving front-line therapy, regardless of the presence of osteolytic bones lesions on conventional radiography. The IMWG made the recommendation even though it is unknown whether bisphosphonates offer any advantage to patients with no bone disease as determined by magnetic resonance imaging or positron-emission tomography/computed tomography.
The panel also recommended the use of intravenous zoledronic acid and pamidronate in the prevention of skeletal-related events over oral bisphosphonates, such as clodronate (not available in the United States), in newly diagnosed myeloma patients because of their antimyeloma effects and survival benefits. Other recommendations include:
According to the report, osteolytic lesions are found in 70% to 80% of newly diagnosed multiple myeloma patients, putting them at increased risk for skeletal-related events, such as spinal cord compression, requiring surgery or palliative radiotherapy to the bone.
“Skeletal-related events impair survival, undermine quality of life, and increase treatment costs,” said panel members. ■
Disclosure: For full disclosure of the study authors, visit www.jco.ascopubs.org.
1. Terpos E, Morgan G, Dimopoulos MA, et al: International Myeloma Working Group Recommendations for the Treatment of Multiple Myeloma-related Bone Disease. J Clin Oncol 31:2347-2357, 2013.