Myeloma bone disease: Clinical features and complications

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Published: 14 May 2019
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Dr Andrew Chantry - University of Sheffield, Sheffield, UK

Dr Andrew Chantry speaks to ecancer at the 2019 MyKE Myeloma meeting in Barcelona about bone disease in multiple myeloma.

He describes the pathophysiology of this disease and the current treatments available to treat this; along with their disadvantages.

Dr Chantry also mentions the psychological effects this disease can cause and states how future efforts should focus on improving these, along with other aspects to improve patient outcomes.

ecancer's filming has been kindly supported by Amgen through the ecancer Global Foundation. ecancer is editorially independent and there is no influence over content.

Myeloma bone disease: Clinical features and complications

Dr Andrew Chantry - University of Sheffield, Sheffield, UK

My research interest is myeloma bone disease and looking for better treatments for this terrible consequence of myeloma. About 80% of patients present with examples of myeloma bone disease and through the course of their disease about 90% of them have serious problems with bone. The mainstay of treatment has been zoledronic acid, which is a very long-acting bisphosphonate that is given intravenously monthly, but does have some quite substantial disadvantages. You can’t use it in substantially renally impaired patients and it does cause some additional problems such as atypical femoral fractures and osteonecrosis of the jaw. Furthermore, zoledronic acid is extremely long-acting and effectively uncouples bone remodelling. So an alternative to zoledronic acid would be desirable.

Denosumab is another antiresorptive agent that targets osteoclasts in a different way. It’s a monoclonal antibody to the RANK ligand molecule that drives osteoclast recruitment. Denosumab is subcutaneously administered and can be used in patients who are renally impaired, so it would be quite an attractive option to use denosumab and also in combination with an anabolic agent if we get that option down the line. Another advantage with its subcutaneous administration is that it could be given in a domiciliary setting to take strain off hospital day wards.

Myeloma bone disease is an underestimated feature of myeloma and in terms of pain, loss of function, loss of employment, the psychological burden of disease is really something that we should try to do better for. We are looking at programs to improve the treatment, not just in terms of better drugs to treat it but also increased access to effective pain relief services, specialist palliative care doctors, better liaison with orthopaedic colleagues when surgical intervention is necessary, physiotherapy and holistic treatments that really bring all elements together to improve outcomes for patients.