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Today’s Speakers:
Beth Faiman, PhD, RN, MSN, APRN-BC, AOCN, BMTCN, FAAN, FAPO
Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
Jens Hillengass, MD, PhD
Roswell Park Comprehensive Cancer Center, Buffalo, New York
Topics We hope to answer all of your bone-related questions! Including…. • Review, why bone health is so important in myeloma • Guidelines for diagnosis and treatment • Provide tips on living well with myeloma bone disease
Background
Multiple Myeloma
Proc
Kyle 2003 Mayo Clin
Multiple Myeloma
Rajkumar 2014. Lancet Oncol. Bridoux 2015 Kidney Int,. Terpos 2021 Lancet Oncol, Hillengass2019 Lancet Oncol
Myeloma Bone Disease
Myeloma Bone Disease
Osteoclasts: • Increased Number of osteoclasts and -activity especially in proximity of myeloma cells Osteoblasts: • Reduced osteoblast activity in proximity of myeloma cells • Normal to increased osteoblast activity in other regions => bone destruction by myeloma leads to formation of a „scar“
Myeloma Bone Disease
adapted from Roodman Leukemia 2009
Myeloma Bone Disease
Comm
Merz 2022 Nature
Myeloma Bone Disease
Merz 2022 Nature Comm
Myeloma Bone Disease
Saad 2007 Cancer, Melton 2005 J Miner Res
Guidelines for Diagnosis
Imaging
Hillengass 2019 Lancet Oncol, Rome 2017 Clin J Oncol, Faiman 2014 Clin Lymphoma Myeloma Leuk, Dimopoulous 2009 Leukemia
Imaging
Edelstyn 1967 Clin Radiol, Hillengass 2017 BCJ
Guidelines for Treatment
Mechanism of Action – Anti-Bone Resorptive Agents
Terpos 2021 Lancet Oncol
Mechanism of Action - Bisphosphonates
adapted from Green The Oncologist 2004
Mechanism of Action - Bisphosphonates
adapted from Green The Oncologist 2004
Mechanism of Action - Bisphosphonates
adapted from Green The Oncologist 2004
Mechanism of Action - Bisphosphonates
adapted from Green The Oncologist 2004
Outcomes - Bisphosphonates
n = 1960
- Improvement of Overall Survival by Zoledronate versus Clodronate
Morgan 2010 Lancet
Mechanism of Action – RANKL - Inhibitors
adapted from Green The Oncologist 2004
Outcomes - Denosumab
Raje 2018 Lancet Oncol
Side Effects - Denosumab
Raje 2017 IMW
Outcomes - Bisphosphonates
Raje 2017 IMW
Side Effects
2012 Ann Oncol
Saad
Side Effects
Adapted from Yamashita 2012 J Evid Base Dent Pract
Duration of Treatment ASCO IMWG EMN ESMO NCCN Initial duration 2 years 1 year continuous 1-2 years in CR/VGPR 2 years Long term Resume at relapse Decrease frequency Continue if <PR According to clinical judgement adapted from Hussain 2022 Blood Rev
Outcomes
Local Therapy
Local Therapy
Kasperk 2012 J Surg Oncol
Summary
Emergency Situations
Guidelines for Physical Activity
General recommendations
2013 JBMR
Orwoll
General recommendations
Huang 2003 J Appl Physiol
CAVEAT: Bone Stability
General recommendations
Resources
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