Bone complications in patients with multiple myeloma in five European countries: a retrospective patient chart review

Abstract

Background: Bone complications (pathologic fracture, spinal cord compression, surgery to bone and radiation to bone) are a common problem in patients with multiple myeloma (MM). We set out to provide insights into the real-world burden of bone complications in patients with newly diagnosed MM (NDMM). Methods: We conducted a retrospective review of medical charts of patients with NDMM whose disease had progressed following first-line treatment in the 3 months before data collection in 2016 in five European countries (France, Germany, Italy, Spain and the United Kingdom). Results: The aggregated study population included 813 patients. Bone pain commonly led to MM diagnosis (63%) and 74% of all patients had two or more bone lesions at initiation of first-line treatment. Furthermore, 26% of patients experienced a new bone complication between MM diagnosis and disease progression following first-line treatment, despite 75% of individuals receiving bisphosphonates. Most bone complications (52%) occurred in the period before initiation of first-line treatment (mean duration: 2.3 months) and more than half of patients (56%) who experienced a new bone complication were hospitalised. Analgesics were used more frequently in patients with bone complications than in those without them (76% vs 50%, respectively). Furthermore, 51% of patients had renal impairment by the time first-line treatment was started. Overall, 25% of patients did not receive bisphosphonates for prevention of bone complications and one in four of those with renal impairment at initiation of first-line treatment did not receive bisphosphonates.Conclusions: Bone complications are common in patients with NDMM. They are frequently associated with hospitalization and analgesic use. Data from this study, conducted in the era of novel anti-myeloma therapies and before the approval of denosumab for use in patients with MM, suggest that although most patients (75%) received bisphosphonates, use of anti-resorptive therapy for prevention of bone complications may be suboptimal in patients with NDMM, irrespective of renal function.

Multiple Myeloma Associated Bone Disease

“…Zoledronic acid should be dose reduced already with a mild to moderate renal impairment (CrCl 30-60 mL/min) and is not recommended in patients with severe renal impairment (<30 mL/min). A recent publication, including patients from 5 European countries, showed that 51 % of all patients had renal insufficiency at the start of first line treatment, and 3% had severe renal impairment [89]. The study also found that a quarter of the patients with sufficient renal function never started bisphosphonate treatment.…”

Carfilzomib Improves Bone Metabolism in Patients with Advanced Relapsed/Refractory Multiple Myeloma: Results of the CarMMa Study

“…This prospective study is the first study in the literature which evaluated, in depth, the effects of Kd combination on bone health in patients with advanced RRMM in a real-world setting. Myeloma bone disease is a common feature for patients with MM; more than 70% present with osteolytic bone disease at diagnosis, whereas bone pain constitutes a very frequent presenting symptom leading to MM diagnosis [ 2 ]. In our study, 36% of the patients had a previous history of SREs at the time of Kd initiation.…”

“…Patients with myeloma bone disease are at high risk of skeletal-related events (SREs) such as pathological fractures, compression of the spinal canal and need for surgery or radiotherapy due to bone-related complications. SREs add significantly to the disease burden by increasing morbidity, mortality and treatment costs [ 2 , 3 ].…”

Approaches and Challenges in the Management of Multiple Myeloma in the Very Old: Future Treatment Prospects

“…Anemia (73%) is attributed to a reduction in erythropoietin production and suppressive effects of excess cytokines on erythropoiesis ( 19 ). Bone involvement (53%) manifests as either pain or pathological fractures due to bone infiltration by plasmacytoma, osteolytic bone lesions and osteoporosis ( 20 ).…”