title: International Myeloma Working Group recommendations for the treatment of multiple myeloma-related bone disease.
abstract: OBJECTIVE
  The aim of the International Myeloma Working Group was to develop practice recommendations for the management of multiple myeloma (MM) -related bone disease.
  
  
  METHODS
  An 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.
  
  
  CONCLUSIONS
  Bisphosphonates (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.
authors.affiliation: Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece. eterpos@med.uoa.gr
authors.forename: Evangelos
authors.initials: E
authors.lastname: Terpos
authors.forename: Gareth
authors.initials: G
authors.lastname: Morgan
authors.forename: Meletios A
authors.initials: MA
authors.lastname: Dimopoulos
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Drake
authors.forename: Suzanne
authors.initials: S
authors.lastname: Lentzsch
authors.forename: Noopur
authors.initials: N
authors.lastname: Raje
authors.forename: Orhan
authors.initials: O
authors.lastname: Sezer
authors.forename: Ramón
authors.initials: R
authors.lastname: García-Sanz
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Shimizu
authors.forename: Ingemar
authors.initials: I
authors.lastname: Turesson
authors.forename: Tony
authors.initials: T
authors.lastname: Reiman
authors.forename: Artur
authors.initials: A
authors.lastname: Jurczyszyn
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Merlini
authors.forename: Andrew
authors.initials: A
authors.lastname: Spencer
authors.forename: Xavier
authors.initials: X
authors.lastname: Leleu
authors.forename: Michele
authors.initials: M
authors.lastname: Cavo
authors.forename: Nikhil
authors.initials: N
authors.lastname: Munshi
authors.forename: S Vincent
authors.initials: SV
authors.lastname: Rajkumar
authors.forename: Brian G M
authors.initials: BG
authors.lastname: Durie
authors.forename: G David
authors.initials: GD
authors.lastname: Roodman
mesh_terms: D061605:Administration, Intravenous; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001847:Bone Diseases / Q000150:complications / Q000188:drug therapy* / Q000532:radiotherapy; D004002:Clodronic Acid / Q000008:administration & dosage / Q000627:therapeutic use; D003131:Combined Modality Therapy; D004164:Diphosphonates / Q000008:administration & dosage / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D050723:Fractures, Bone / Q000175:diagnosis / Q000517:prevention & control; D006801:Humans; D007093:Imidazoles / Q000008:administration & dosage / Q000627:therapeutic use; D007391:International Cooperation; D008279:Magnetic Resonance Imaging; D008495:Medical Oncology / Q000458:organization & administration; D009101:Multiple Myeloma / Q000150:complications / Q000188:drug therapy* / Q000532:radiotherapy; D010020:Osteonecrosis / Q000175:diagnosis / Q000517:prevention & control; D017063:Outcome Assessment, Health Care / Q000379:methods; D000077268:Pamidronate; D049268:Positron-Emission Tomography; D017410:Practice Guidelines as Topic; D011878:Radiotherapy / Q000379:methods; D014057:Tomography, X-Ray Computed; D000077211:Zoledronic Acid
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D004002:Clodronic Acid; D000077211:Zoledronic Acid; D000077268:Pamidronate