title: Increasing bone sclerosis during bortezomib therapy in multiple myeloma patients: results of a reduced-dose whole-body MDCT study.
abstract: OBJECTIVE
  The objective of our study was to assess the frequency, location, extent, and patterns of bone sclerosis occurring in patients with multiple myeloma (MM) during bortezomib-based therapy.
  
  
  METHODS
  From June 2003 through December 2011, 593 whole-body reduced-dose MDCT studies were performed of 79 consecutive patients receiving bortezomib. The median surveillance time was 21 months (range, 3-67 months). Baseline studies were compared with follow-up studies during therapy (follow-up 1), at the end of therapy (follow-up 2), and 12 months after cessation of bortezomib therapy (follow-up 3). We recorded any sclerotic change occurring inside or along the margins of the osteolytic lesions, in the cancellous bone, or inside preexistent medullary or extramedullary lesions. The time point of occurrence of bone sclerosis was correlated with the best hematologic response category.
  
  
  RESULTS
  Fourteen (17.7%) patients developed focal (n = 11) or diffuse (n = 3) bone sclerosis. The time window from bortezomib initiation to radiographic detection of bone sclerosis was 8 months (SD, 7 months). Sclerosis occurred at multiple sites (n = 7) or at an isolated site (n = 7). On subsequent whole-body reduced-dose MDCT studies, sclerosis further increased in seven (50%) patients. Hematologic best response during bortezomib treatment was complete response (n = 1), very good partial response (n = 2), partial response (n = 8), and stable disease (n = 3). Radiologic response at the time of sclerosis detection was partial response (n = 8), stable disease (n = 2), and progressive disease (n = 4).
  
  
  CONCLUSIONS
  Bone remineralization may occur during bortezomib-based therapy for MM in a substantial proportion of patients. The extent, location, and patterns of sclerosis differ among patients and are unpredictable. Sclerosis was documented even in patients showing suboptimal hematologic response.
authors.affiliation: 1 Department of Diagnostic Radiology, Eberhard Karls University, Hoppe-Seyler-Strasse 3, 72076 Tübingen, Germany.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Schulze
authors.forename: Katja
authors.initials: K
authors.lastname: Weisel
authors.forename: Caroline
authors.initials: C
authors.lastname: Grandjean
authors.forename: Katharina
authors.initials: K
authors.lastname: Oehrlein
authors.forename: Manola
authors.initials: M
authors.lastname: Zago
authors.forename: Daniel
authors.initials: D
authors.lastname: Spira
authors.forename: Marius
authors.initials: M
authors.lastname: Horger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001847:Bone Diseases / Q000139:chemically induced* / Q000000981:diagnostic imaging*; D001897:Boronic Acids / Q000009:adverse effects*; D000069286:Bortezomib; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy*; D011719:Pyrazines / Q000009:adverse effects*; D011829:Radiation Dosage; D012189:Retrospective Studies; D012307:Risk Factors; D012598:Sclerosis / Q000139:chemically induced / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed / Q000379:methods*; D051598:Whole Body Imaging
chemical_list: D000970:Antineoplastic Agents; D001897:Boronic Acids; D011719:Pyrazines; D000069286:Bortezomib