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14th International Myeloma Workshop /
Myeloma bone disease: background and latest

3rd - 7th Apr 2013

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Published: 04.04.13
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Prof Evangelos Terpos, Prof Michel Delforge

Prof Evangelos Terpos and Prof Michel Delforge talk to ecancertv at the 14th International Myeloma Workshop (IMW 2013), 3-7th May 2013, Kyoto.

Myeloma bone disease (MBD) is the most common complication of multiple myeloma (MM). Around 70-80% of patients have bone related pain. MBD can lead to pathological fractures and so impact significantly on patient quality of life.

Conventional radiography remains the cornerstone of diagnosis but will only detect MBD once around 30% of bone loss has occurred. Whole body CT, PET/CT and MRI are more sensitive imaging techniques. CT and PET/CT detect lytic lesions, while MRI detects bone marrow involvement and pattern of involvement.

Bisphosphonates are the standard of care for the treatment of MBD. Recent data from the MRC Myeloma IX Study showed a benefit in reducing skeletal events and also a significant improvement in overall survival with zoledronic acid. Duration of treatment with bisphosphonates was initially for life, but was then reduced to 2 years because of side effects. Now it is believed that therapy could be extended beyond 2 years for patients who experience a partial response to anti-myeloma therapy and can be restarted in patients who relapse.

Bisphosphonates have a number of side effects, including renal effects and osteonecrosis of the jaw (ONJ). Patients need to be monitored and treatment tailored according to renal function. ONJ can be prevented with regular dental examinations and avoidance of unnecessary dental procedures. It is recommended that bisphosphonates are discontinued for 3 months before any dental work is carried out.

Denosumab is a novel inhibitor of RANKL undergoing Phase III research. Other targets includes MIP 1 alpha, DKK1, activin A and sclerostin. Proteasome inhibitors have also been shown to have profound bone effects.
Combination bortezomib-based  therapy could be beneficial in these patients.

This programme has been supported by an unrestricted educational grant from Janssen Pharmaceutica (A Johnson & Johnson Company).

Previous conferences: highlights



Founding partners

European Cancer Organisation European Institute of Oncology

Founding Charities

Foundazione Umberto Veronesi Fondazione IEO Swiss Bridge

Published by

ecancer Global Foundation