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CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2023; 58(03): 368-377
DOI: 10.1055/s-0043-1770150
Artigo de Atualização
Oncologia

Multiple Myeloma (Part 2) - Update on The Approach to Bone Disease

Article in several languages: português | English
Alex Guedes 
1   Grupo de Oncologia Ortopédica, Hospital Santa Izabel, Santa Casa de Misericórdia da Bahia, Salvador, BA, Brasil
,
Ricardo Gehrke Becker 
2   Serviço de Trauma Ortopédico, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
,
Luiz Eduardo Moreira Teixeira 
3   Departamento do Aparelho Locomotor, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
› Author Affiliations Funding There was no funding.
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Abstract

The increase in life expectancy of the world population has led to a concomitant increase in the prevalence of multiple myeloma (MM), a disease that usually affects the elderly population. Bone lesions are frequent in patients with this condition, demanding an early approach, from drug treatment, through radiotherapy to orthopedic surgery (prophylactic or therapeutic) with the objective of preventing or delaying the occurrence of fracture, or, when this event has already occurred, treat it through stabilization or replacement (lesions located in the appendicular skeleton) and/or promote stabilization and spinal cord decompression (lesions located in the axial skeleton), providing rapid pain relief, return to ambulation and resocialization, returning quality of life to patients. The aim of this review is to update the reader on the findings of pathophysiology, clinical, laboratory and imaging, differential diagnosis and therapeutic approach of multiple myeloma bone disease (MMBD).

Keywords

Diphosphonates - Fractures Spontaneous - Multiple myeloma - Prophylactic Surgical procedures - Orthopedic procedures - Radiotherapy.


Publication History

Received: 09 August 2022

Accepted: 16 December 2022

Article published online:
29 June 2023

© 2023. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • Referências

  • 1 Hungria VTM. Doença óssea em mieloma múltiplo. Rev Bras Hematol Hemoter 2007; 29 (01) 60-66
    Google Scholar
  • 2 Kehrer M, Koob S, Kehrer A, Wirtz DC, Schmolders J. Multiple myeloma - Current standards in surgical treatment. Z Orthop Unfall 2019; 157 (02) 164-172
    Google Scholar
  • 3 Galán-Olleros M, Marco J, Oteo D. et al. Orthopedic surgical treatment and perioperative complications in multiple myeloma bone disease: Analysis of a series (2009-2018). Ann Surg Oncol 2021; 28 (02) 1158-1166
    Google Scholar
  • 4 Kyle RA, Gertz MA, Witzig TE. et al. Review of 1027 patients with newly diagnosed multiple myeloma. Mayo Clin Proc 2003; 78 (01) 21-33
    Google Scholar
  • 5 Ponte FM, Garcia Filho RJ, Hadler MB, Korukian M, Ishihara HY. Avaliação do tratamento ortopédico no mieloma múltiplo. Rev Bras Ortop 2002; 37 (05) 162-170
    Google Scholar
  • 6 Katsekis KS, Kelham AS. Orthopaedic management of multiple myeloma lesions. JBJS J Orthop Physician Assist 2018; 6 (04) e40
    Google Scholar
  • 7 Utzschneider S, Schmidt H, Weber P, Schmidt GP, Jansson V, Dürr HR. Surgical therapy of skeletal complications in multiple myeloma. Int Orthop 2011; 35 (08) 1209-1213
    Google Scholar
  • 8 Terpos E, Zamagni E, Lentzsch S. et al; Bone Working Group of the International Myeloma Working Group. Treatment of multiple myeloma-related bone disease: recommendations from the Bone Working Group of the International Myeloma Working Group. Lancet Oncol 2021; 22 (03) e119-e130
    Google Scholar
  • 9 Lentzsch S, Ehrlich LA, Roodman GD. Pathophysiology of multiple myeloma bone disease. Hematol Oncol Clin North Am 2007; 21 (06) 1035-1049 , viii
    Google Scholar
  • 10 Rajkumar SV. Multiple myeloma: 2020 update on diagnosis, risk-stratification and management. Am J Hematol 2020; 95 (05) 548-567
    Google Scholar
  • 11 American Academy of Orthopaedic Surgeons [Internet]. Orthoinfo; c2020. Diseases & Conditions: Multiple Myeloma/Plasmacytoma [cited 2022 Mar 12]. Available from: https://orthoinfo.aaos.org/en/diseases--conditions/multiple-myelomaplasmacytoma/
  • 12 Surgeon's Committee of the Chinese Myeloma Working Group of the International Myeloma Foundation. Consensus on Surgical Management of Myeloma Bone Disease. Orthop Surg 2016; 8 (03) 263-269
    Google Scholar
  • 13 Guedes A, Oliveira MBDR, Costa FM, de Melo AS. Updating on Bone and Soft Tissue Sarcomas Staging. Rev Bras Ortop 2021; 56 (04) 411-418
    Google Scholar
  • 14 Guedes A, Oliveira MBDR, de Melo AS, Carmo CCMD. Update in Imaging Evaluation of Bone and Soft Tissue Sarcomas. Rev Bras Ortop 2023; 58 (02) 179-190
    Google Scholar
  • 15 Guedes A, Moreira FD, Mattos ESR, Freire MDM, Guedes AAL, Freire ANM. Abordagem ortopédica das metástases ósseas de carcinoma e mieloma múltiplo. Rev SBC 2022; 23 (62) 83-90
    Google Scholar
  • 16 Guedes A. Mieloma múltiplo. In: Oliveira LG. ed. Tratado de doenças osteometabólicas. Goiânia: Kelps; 2020: 795-818
    Google Scholar
  • 17 Rudzianskiene M, Inciura A, Gerbutavicius R. et al. Single vs. multiple fraction regimens for palliative radiotherapy treatment of multiple myeloma : A prospective randomised study. Strahlenther Onkol 2017; 193 (09) 742-749
    Google Scholar
  • 18 Kyriakou C, Molloy S, Vrionis F. et al. The role of cement augmentation with percutaneous vertebroplasty and balloon kyphoplasty for the treatment of vertebral compression fractures in multiple myeloma: a consensus statement from the International Myeloma Working Group (IMWG). Blood Cancer J 2019; 9 (03) 27
    Google Scholar
  • 19 Hirsch AE, Jha RM, Yoo AJ. et al. The use of vertebral augmentation and external beam radiation therapy in the multimodal management of malignant vertebral compression fractures. Pain Physician 2011; 14 (05) 447-458
    Google Scholar
  • 20 Palumbo A, Avet-Loiseau H, Oliva S. et al. Revised international staging system for multiple myeloma: A report from International Myeloma Working Group. J Clin Oncol 2015; 33 (26) 2863-2869
    Google Scholar
  • 21 Piccioli A, Piana R, Lisanti M. et al; Italian Orthopaedic Society (SIOT) Bone Metastasis Study Group. Carbon-fiber reinforced intramedullary nailing in musculoskeletal tumor surgery: a national multicentric experience of the Italian Orthopaedic Society (SIOT) Bone Metastasis Study Group. Injury 2017; 48 (Suppl. 03) S55-S59
    Google Scholar
  • 22 Soriani A, Strigari L, Petrongari MG. et al. The advantages of carbon fiber based orthopedic devices in patients who have to undergo radiotherapy. Acta Biomed 2020; 91 (03) e2020057
    Google Scholar
  • 23 Sakellariou VI, Mavrogenis AF, Savvidou O, Sim FH, Papagelopoulos PJ. Reconstruction of multiple myeloma lesions around the pelvis and acetabulum. Eur J Orthop Surg Traumatol 2015; 25 (04) 643-653
    Google Scholar
  • 24 Gazendam A, Axelrod D, Wilson D, Ghert M. Emerging Concepts in the Surgical Management of Peri-Acetabular Metastatic Bone Disease. Curr Oncol 2021; 28 (04) 2731-2740
    Google Scholar
  • 25 Ogawa R, Hirao M, Umezu T, Yanagimoto S. Total Hip Arthroplasty with a Cementless Acetabular Component and Impaction Bone Grafting for Dysplastic Osteoarthritis Complicated by Multiple Myeloma. Case Rep Orthop 2022; 2022: 3939356
    Google Scholar
  • 26 Wangsaturaka P, Asavamongkolkul A, Waikakul S, Phimolsarnti R. The results of surgical management of bone metastasis involving the periacetabular area: Siriraj experience. J Med Assoc Thai 2007; 90 (05) 1006-1013
    Google Scholar
  • 27 Milavec H, Ravikumar N, Syn NL, Yentia Soekojo C, Chng WJ, Kumar N. Surgical Management of Multiple Myeloma With Symptomatic Involvement of the Spine. Int J Spine Surg 2020; 14 (05) 785-794
    Google Scholar
  • 28 Laufer I, Rubin DG, Lis E. et al. The NOMS framework: approach to the treatment of spinal metastatic tumors. Oncologist 2013; 18 (06) 744-751
    Google Scholar
  • 29 Mirels H. Metastatic disease in long bones. A proposed scoring system for diagnosing impending pathologic fractures. Clin Orthop Relat Res 1989; (249) 256-264
    Google Scholar
  • 30 Jawad MU, Scully SP. In brief: classifications in brief: Mirels' classification: metastatic disease in long bones and impending pathologic fracture. Clin Orthop Relat Res 2010; 468 (10) 2825-2827
    Google Scholar
  • 31 Gerrand CH, Rankin K. Metastatic Disease in Long Bones. A Proposed scoring system for diagnosing impending pathologic fractures. In: Banaszkiewicz P, Kader DF. eds. Classic papers in orthopaedics. London: Springer; 2014: 479-480
    Google Scholar
  • 32 Topkar OM, Erol B. Clinical outcomes and complications of surgical interventions for multiple myeloma lesions in the extremities and pelvis: A retrospective clinical study. Acta Orthop Traumatol Turc 2021; 55 (02) 159-165
    Google Scholar