title: Long-term survival after surgical intervention for bone disease in multiple myeloma.
abstract: BACKGROUND
  We describe the surgical treatment, outcome and long-term survival of patients with multiple myeloma (MM) in response to conventional (CC) or high-dose (HDT) chemotherapy.
  
  
  METHODS
  Eighty-four patients diagnosed with MM were recruited for the study (51 male, 33 female; median age 62 years) and consecutively surgically treated in a single institution during a 12-year period. The main end point of the study was overall survival after surgery. Cox regression analysis was used to estimate the effect of factors that may predict survival.
  
  
  RESULTS
  Spinal surgery was performed in 54 cases, and 30 patients were surgically treated at the extremities. The post-surgical complication rate was low (17%; 14/84 patients). The median overall survival time was 47 months. Patients receiving HDT had a longer 5-year overall survival rate than patients receiving CC (51% versus 33%). Univariate predictors of mortality included age >65 years [risk ratio (RR) 1.62; P=0.023], osteolyses in long weight-bearing bones (RR 2.23; P=0.007) and an elevated C-reactive protein level >5 mg/l (RR 1.82; P=0.016); the latter remained significant as a predictor in multivariate analysis (RR 2.66; P=0.0209).
  
  
  CONCLUSIONS
  Given the high number of patients reaching 5-year overall survival and the low post-surgery complication rate, surgery should pursue a long-term stable reconstruction of the affected bone.
authors.affiliation: Department of Orthopedic Surgery, University of Heidelberg, Schlierbacher Landstrasse 200, D-69181 Heidelberg, Germany. felix.zeifang@ok.uni-heidelberg.de
authors.forename: F
authors.initials: F
authors.lastname: Zeifang
authors.forename: A
authors.initials: A
authors.lastname: Zahlten-Hinguranage
authors.forename: H
authors.initials: H
authors.lastname: Goldschmidt
authors.forename: F
authors.initials: F
authors.lastname: Cremer
authors.forename: L
authors.initials: L
authors.lastname: Bernd
authors.forename: D
authors.initials: D
authors.lastname: Sabo
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery*; D010014:Osteolysis; D036102:Peripheral Blood Stem Cell Transplantation; D011183:Postoperative Complications; D016019:Survival Analysis; D016896:Treatment Outcome; D016474:Weight-Bearing