JCO：国际骨髓瘤工作组多发性骨髓瘤相关骨骼疾病治疗推荐规范

推荐规范：对于所有接受抗骨髓瘤一线治疗的MM患者，无论根据传统的X摄像是否存在溶骨病变，都应考虑使用双磷酸盐类药物(BP)。然而对于经核磁共振成像或正电子发射断层扫描/计算机断层扫描确定无骨骼疾病的患者，尚不清楚是否可通过BP获益。推荐静脉注射(IV)唑来膦酸(ZOL)或帕米膦酸(PAM)预防MM患者发生骨骼相关事件。鉴于ZOL具有潜在抗骨髓瘤效果及生存获益，对于MM新确诊患者优先推荐ZOL而非氯膦酸盐。在初始治疗期间，应每3至4周进行一次IV治疗。活跃期骨髓瘤患者应继续进行ZOL或PAM治疗，对于取得完全缓解或较佳部分缓解的患者，在暂停用药后出现病情复发，应重新进行ZOL或PAM治疗。尽管BP耐受性良好，但务必做好预防策略，以避免发生肾脏毒性或腭骨坏死。对于椎体性压缩骨折症状患者应考虑进行椎体后凸成形手术治疗。对于疼痛无法控制、行将发生病理性骨折或脊髓受压的患者，可通过低剂量放疗减轻相关症状。应就长骨骨折、脊髓受压及脊柱不稳等问题进行整形咨询。

 

International Myeloma Working Group Recommendations for the Treatment of Multiple Myeloma-Related Bone Disease.
Abstract
PURPOSEThe aim of the International Myeloma Working Group was to develop practice recommendations for the management of multiple myeloma (MM) -related bone disease.MethodologyAn interdisciplinary panel of clinical experts on MM and myeloma bone disease developed recommendations based on published data through August 2012. Expert consensus was used to propose additional recommendations in situations where there were insufficient published data. Levels of evidence and grades of recommendations were assigned and approved by panel members.RecommendationsBisphosphonates (BPs) should be considered in all patients with MM receiving first-line antimyeloma therapy, regardless of presence of osteolytic bone lesions on conventional radiography. However, it is unknown if BPs offer any advantage in patients with no bone disease assessed by magnetic resonance imaging or positron emission tomography/computed tomography. Intravenous (IV) zoledronic acid (ZOL) or pamidronate (PAM) is recommended for preventing skeletal-related events in patients with MM. ZOL is preferred over oral clodronate in newly diagnosed patients with MM because of its potential antimyeloma effects and survival benefits. BPs should be administered every 3 to 4 weeks IV during initial therapy. ZOL or PAM should be continued in patients with active disease and should be resumed after disease relapse, if discontinued in patients achieving complete or very good partial response. BPs are well tolerated, but preventive strategies must be instituted to avoid renal toxicity or osteonecrosis of the jaw. Kyphoplasty should be considered for symptomatic vertebral compression fractures. Low-dose radiation therapy can be used for palliation of uncontrolled pain, impending pathologic fracture, or spinal cord compression. Orthopedic consultation should be sought for long-bone fractures, spinal cord compression, and vertebral column instability.