Osteolytic bone disease is present in about 80% of patients with multiple myeloma at the time of diagnosis. Managing bone disease in patients with multiple myeloma is a challenge and requires a multi-faceted treatment approach with medication, surgery, and radiation. The established treatments with intravenous or subcutaneous antiresorptives can cause debilitating adverse events for patients, mainly osteonecrosis of the jaw, which, traditionally, has been difficult to manage. Now, oral surgery is recommended and proven successful in 60–85% of patients. Patients with spinal involvement may benefit from surgery in the form of vertebroplasty and kyphoplasty for pain relief, improved mobility, and reestablished sagittal balance, as well as the restoration of vertebral height. These procedures are considered safe, but the full therapeutic impact needs to be investigated further. Ixazomib, the first oral proteasome inhibitor, increases osteoblast differentiation, and recently published preliminary results in patients treated with Ixazomib maintenance have promisingly shown increased trabecular volume caused by prolonged bone formation activity. Other novel potential treatment strategies are discussed as well.
约80%的多发性骨髓瘤患者在确诊时已存在溶骨性骨病。多发性骨髓瘤骨病的治疗具有挑战性，需要药物、手术和放射治疗相结合的综合治疗方案。目前静脉或皮下注射抗骨吸收药物的标准治疗可能导致患者出现衰弱性不良事件，主要是颌骨坏死，传统上这一并发症难以处理。目前推荐采用口腔手术治疗，并已证实对60%-85%的患者有效。对于脊柱受累患者，椎体成形术和后凸成形术可缓解疼痛、改善活动能力、重建矢状面平衡并恢复椎体高度，使患者获益。这些手术被认为是安全的，但其完整治疗效果仍需进一步研究。伊沙佐米作为首个口服蛋白酶体抑制剂，可促进成骨细胞分化，近期公布的伊沙佐米维持治疗患者初步研究结果显示，该药物通过延长骨形成活性增加骨小梁体积，展现出良好前景。本文还讨论了其他新型潜在治疗策略。
Novel Developments in the Treatment of Multiple Myeloma-Associated Bone Disease
肿瘤(癌症)患者之家