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Temporary diagnostics and treatment of myeloma bone disease in clinical practice


Authors: V. Ščudla 1;  Z. Adam 2
Authors‘ workplace: III. interní – nefrologická, revmatologická a endokrinologická klinika Lékařské fakulty UP a FN Olomouc, přednosta prof. MUDr. Josef Zadražil, CSc. 1;  Interní hematologická a onkologická klinika Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Jiří Mayer, CSc. 2
Published in: Vnitř Lék 2012; 58(7 a 8): 164-174
Category: 60th Birthday prof. MUDr. Miroslav Penka, CSc.

Overview

The presented paper demonstrates clinical manifestations of myeloma bone disease and its position within diagnostics, differential diagnostics and stratification of multiple myeloma. Attention is drawn to the role of conventional and modern imaging techniques, especially to whole body magnetic resonance (WB-MR), positron emission tomography/computed tomography, and other radionuclide imaging methods (MIBI scintigraphy of the skeleton). We touch also the role of dual energy X-ray absorptiometry, and the evaluation of biomarkers of bone metabolism in the assessment of the state and evolution of myeloma bone disease. We aim at present therapeutic modalities of myeloma bone disease with stress on bisphosphonate therapy, and we outline also new perspective alternatives of targeted therapy based on pathogenesis of myeloma bone disease, i.e. the use of antagonists and inhibitors of those molecules that interfere with osteoclastic bone resorption and osteoblastic osteoformation, e.g. monoclonal antibody against RANKL (denosumab) or proteasome inhibitors (bortezomib, carfilzomib). We conclude that effective diagnostics and treatment of myeloma bone disease significantly contributes to the improvement of quality of life and overall survival in patients with multiple myeloma.

Key words:
myeloma bone disease – whole body-magnetic resonance – positron emission tomography/computed tomography – biomarkers of bone metabolism – bisphosphonates – denosumab – bortezomib


Sources

1. International Myeloma Working Group. Criteria for the clasification of monoclonal gammopathies, multiple myeloma and related disorders: a report of the International myeloma working group. Brit J Haematol 2003; 121: 749–757.

2. Dimopoulos M, Terpos E, Comenzo RL et al. International myeloma working group consensus statement and guidelines regarding the current role of imaging techniques in the diagnosis and monitoring of multiple myeloma. Leukemia 2009; 23: 1545–1556.

3. Ščudla V. Postižení skeletu u mnohočetného myelomu. Postgrad Med 2011; 13: 728–736.

4. Adam Z, Ševčík P, Vorlíček J et al. Kostní nádorová choroba. Praha: Grada Publishing 2005.

5. Mundy GR, Raisz LG, Cooper RA et al. Evidence for the secretion of an osteoclast stimulating factor in myeloma. N Engl J Med 1974; 291: 1041–1046.

6. Roodman GD. Diagnosis and treatment of myeloma bone disease. In: Rajkumar SV et al. Treatment of multiple myeloma and related dis­orders. Cambridge: Cambridge University Press 2009: 64–75.

7. Ščudla V. Bisfosfonáty v léčbě mnohočetného myelomu. Remedia 2008; 18: 47–56.

8. Vaníček J, Krupa P, Adam Z. Přínos jednotlivých zobrazovacích metod pro diagnostiku a sledování aktivity mnohočetného myelomu. Vnitř Lék 2010; 56: 585–590.

9. Mulligan M, Smith S, Talmi D. Whole body radiography for bone survey screening of cancer and myeloma patients. Cancer Invest 2008; 26: 916–922.

10. Lütje S, De Rooy JW, Croockewit S et al. Role of radiography, MRI and FDG-PET/CT in diagnosing, staging and therapeutical evaluation of patients with multiple myeloma. Ann Hematol 2009; 88: 1161–1168.

11. Zamagni E, Nanni C, Patriarca F et al. A prospective comparison of 18F-fluorodeoxyglucose positron emission tomography-computed tomography, magnetic resonance imaging and whole-body planar radiographs in the assessment of bone disease in newly diagnosed multiple myeloma. Haematologica Hematol J 2007; 92: 50–55.

12. Bäuerle T, Hillengass J, Fechtner K et al. Multiple myeloma and monoclonal gammopathy of undetermined significance: importance of whole-body versus spinal MR imaging. Radiology 2009; 252: 477–485.

13. Durie BG. The role of anatomic and func­tional staging in myeloma: description of Durie//Salmon plus staging system. Eur J Cancer 2006; 42: 1539–1543.

14. Heřman M, Hrbek J, Ščudla V et al. Korelace nálezů celotělového MR a stážovacího systému Durie/Salmon u pacientů s monoklonální gamapatií nejistého významu a mnohočetným myelomem. Čs Radiol 2010; 64: 203–212.

15. Abildgaard N, Brixen K, Eriksen EF et al. Sequential analysis of biochemical markers of bone resorption and bone densitometry in multiple myeloma. Haematologica 2004; 89: 567–577.

16. Lacy MQ, Dispenzieri A, Gertz M et al. Mayo clinic consensus statement for the use of bisphosphonates in multiple myeloma. Mayo Clin Proc 2006; 81: 1047–1053.

17. Terpos F, Gastritis E, Rousnou M et al. The combination of bortezomib, melphalan, dexamethasone and intermittent thalidomide is an effective regimen for relapsed/refractory myeloma and is associated with improvement of abnormal bone metabolism and angiogenesis. Leukemia 2008; 22: 2247–2256.

18. Berenson JR. The use of bisphosphonates in patients with multiple myeloma. Up ToDate 2012. www.uptodate.com.

19. Mysliveček M, Nekula J, Bačovský J. Zobrazovací metody v diagnostice a sledování mnohočetného myelomu. Vnitř Lék 2006; 52: 46–54

20. Bredella MA, Steinbach L, Caputo G et al. Value of FDG PET in the assessment of patients with multiple myeloma. Am J Roentgenol 2005; 184: 1199–1204.

21. Terpos E. Biochemical markers of bone metabolism in multiple myeloma. Cancer Treat Rev 2006; 32: 15–19.

22. Fonseca R, Trendle MC, Leong T et al. Prognostic value of serum markers of bone metabolism in untreated multiple myeloma patients. Br J Haematol 2000; 109: 24–29.

23. Zangari M, Esseltine D, Cavallo F et al. Predictive value of alkaline phosphatase for response and time to progression in bortezomib-treated multiple myeloma patients. Am J Hematol 2007; 82: 831–833.

24. Robbiani DF, Thesi M, Bergsagel PL. Bone lesions in molecular subtypes of multiple myeloma. N Engl J Med 2004; 351: 197–198.

25. Terpos E, Sezer O, Croucher PI et al. European Myeloma Network. The use of bisphosphonates in multiple myeloma: recommendations of an expert panel on behalf of the European myeloma network. Ann Oncol 2009; 20: 1303–1317.

26. Morgan G, Davies F, Gregory W et al. Evaluating the effects of zoledronic acid (ZOL) on overall survival (OS) in patients (Pts) with multiple myeloma (MM): Results of the Medical research council (MRC) myeloma IX study. J Clin Oncol 2010; 28: 8021–8022.

27. Raje N, Roodman GD. Advances in the biology and treatment of bone disease in multiple myeloma. Clin Cancer Res 2011; 17: 1278–1286.

28. Musto P, Petrucci MT, Bringhen S et al. GIMEMA (Italian Group for Adult Hematologic Diseases)/Multiple Myeloma Working Party and the Italian Myeloma Network. A multicentric, randomized clinical trial comparing zoledronic acid versus observation in patients with symptomatic myeloma. Cancer 2008; 113: 1588–1595.

29. Berenson JR, Hillner BE, Kyle RA et al. American society of clinical oncology bisphosphonates expert panel. American society of clinical oncology clinical practice guidelines: the role of bisphosphonates in multiple myeloma. J Clin Oncol 2002; 20: 3719–3736.

30. Djulbegovic B, Wheatley K, Ross J et al. Bisphosphonates in multiple myeloma. Cochrane Database Syst Rev 2002; 3: CD 003188.

31. Kyle RA, Yee GC, Somerfield MR et al. Anderson K; American Society of Clinical Oncology. American society of clinical oncology 2007 clinical practice guideline update on the role of bisphosphonates in multiple myeloma. J Clin Oncol 2007; 25: 2464–2472.

32. Durie BG. Use of bisphosphonates in multiple myeloma: IMWG response to Mayo Clinic consensus statement. Mayo Clin Proc 2007; 82: 516–517.

33. Gimsing P, Carlson K, Fayers P et al. Randomised study on prophylactic pamidronate 30 mg versus 90 mg in multiple myeloma. Blood 2007; 110: Abstract 533.

34. Coleman RE, Major P, Lipton A et al. Predictive value of bone resorption and formation markers in cancer patients with bone metastases receiving the bisphosphonate zoledronic acid. J Clin Oncol 2005; 23: 4925–4935.

35. D’Arena G, Gobbi PG, Broglia C et al. Gimema (Gruppo Italiano Malattie Ematologiche Dell‘Adulto); Multiple Myeloma Working Party; Gisl (Gruppo Italiano Studio Linfomi) Cooperative Group. Pamidronate versus observation in asymptomatic myeloma; final results with long-term follow-up a randomized study. Leuk Lymphoma 2011; 52: 771–779.

36. Mhaskar R, Redzepovic J, Wheatley K et al. Bisphosphonates in multiple myeloma. Cochrane Database Syst Rev 2010; CD003188.

37. Anderson KC, Alsina M, Bensinger W et al. National comprehensive cancer network (NCCN). Multiple myeloma guidelines. Clinical practice guidelines in oncology. J Natl Copr Canc Netw 2007; 5: 118–127.

38. Harrouseau JL, Greil R, Kloke O. ESMO Guidelines Task Force. ESMO minimum clinical reccomendations for diagnosis, treatment and follow-up of multiple myeloma. Ann Oncol 2005; 16: 145–147.

39. Henry DH, Costa L, Goldwasser F et al. Randomized, double-blind study of denosumab versus zoledronic acid in the treatment of bone metastases in patients with advanced cancer (excluding breast and prostate cancer) or multiple myeloma. J Clin Oncol 2011; 29: 1125–1132.

40. Body JJ, Facon T, Coleman RE et al. A study of the biological receptor activator of nuclear factor-kappaB ligand inhibitor, denosumab, in patients with multiple myeloma or bone metastases from breast cancer. Clin Cancer Res 2006; 12: 1221–1228.

41. Fitazi K, Lipton A, Mariette X et al. Randomized phase II trial of denosumab in patients with bone metastases from prostate cancer, breast cancer, or other neoplasms after intravenous bisphosphonates. J Clin Oncol 2009; 27: 1564–1571.

42. Sezer O. Myeloma bone disease: recent advances in biology, diagnosis and treatment. Oncologist 2009; 14: 276–283.

43. Christoulas D, Terpos E, Dimopoulos MA. Pathogenesis and management of myeloma bone disease. Expert Rev Hematol 2009; 2: 385–398.

44. Zangari M, Terpos E, Zhan F et al. Impact of bortezomib on bone health in myeloma: a review of current evidence. Cancer Treat Rev 2012, doi:10.1016/j.ctrv.2011.12.007.

45. Von Metzler I, Krebbel H, Hecht M et al. Bortezomib inhibits human osteoclastogenesis. Leukemia 2007; 21: 2025–2034.

46. Giuliani N, Morandi F, Tagliaferri S et al. The proteosome inhibitor bortezomib affects osteoblast differentiation in vitro and in vivo in multiple myeloma patients. Blood 2007; 110: 334–338.

47. San Miguel JF, Schlag R, Khuageva NK et al. VISTA Trial Investigators. Bortezomib plus melphalan and prednisone for initial treatment of multiple myeloma. N Engl J Med 2008; 359: 906–917.

48. Adam Z, Vorlíček J, Vaníček J et al. Diagnostické a léčebné postupy u maligních chorob. 1. vyd. Praha: Grada-Springer Verlag 2004.

49. Hájek R, Adam Z, Maisnar V et al. Česká myelomová skupina. Souhrn doporučení 2012 Diagnostika a léčba mnohočetného myelomu. Transfuze Hematol dnes 2012; (připraveno k tisku).

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