Myeloma management guidelines: a consensus report from the Scientific Advisors of the International Myeloma Foundation

Abstract

These consensus guidelines have been compiled with input from the Scientific Advisors of the International Myeloma Foundation. Their production involved several steps including: A 3-day Scientific Advisors meeting, during which each specific area was presented and discussed (May 2002). Review of key literature, especially randomized study results, but also Medline, Internet, Cochrane database searches, and prior guidelines (Br J Haematol 115: 522-540, 2001). Feedback from patients participating in the International Myeloma Foundation, patient programs. These guidelines encompass both the published literature and expert opinions. Recommendations based upon expert opinions are identified as such. The intent is for the guidelines to be international in scope, plus provide recommendations for both clinical practice and research approaches. 'Consensus' reflects general, although not necessarily unanimous, agreement. Details are discussed as appropriate. For convenience, the recommendations are divided into: 1. Diagnostic criteria. 2. Staging and prognostic factors. 3. Frontline therapy. 4. High-dose therapy and transplant. 5. Maintenance therapy. 6. Supportive care and management of specific complications. 7. Novel therapies and new technologies.

Preoperative elevation of serum C – reactive protein is predictive for prognosis in myeloma bone disease after surgery

“…This specific feature of high-serum CRP concentration and hypoalbuminemia in some myeloma patients has been addressed earlier with regard to disease activity (Alexandrakis et al, 2003;Durie et al, 2003). In contrast to high preoperative CRP levels, we did not find B2-microglobulin as predictive parameter.…”

“…Although elevations of C-reactive protein (CRP) serum levels in newly diagnosed patients with myeloma bone disease have been consistently associated with a poor prognosis (Bataille et al, 1992;Tienhaara et al, 1994;Durie et al, 2003) the significance of preoperative CRP levels have not been clarified as of prognostic importance in myeloma patients, yet, and was, for the first time, subject of this study. The major finding of this investigation is the inferior survival of patients with myeloma bone disease in whom CRP was elevated prior to surgery.…”

“…Although the outcome has improved with a median survival of 4 -5 years since the introduction of high-dose therapy (HDT) with peripheral blood stem cell transplantation (PBSCT) and new drugs like Thalidomide and Bortezomib, aggressive features of myeloma bone lesions have significantly contributed to a poor outcome (Durie et al, 2003;Tricot et al, 2004;Morgan and Davies, 2005;Rajkumar and Kyle, 2005;Glasmacher et al, 2006).…”

Medication-Related Osteonecrosis of the Jaws (MRONJ) Induced by Incompatible Complete Removable Denture: A Case Report

“…Additional hydration, dosage reduction and less frequent administration are useful suggestions. [7] Despite great benefits of antiresorptives in MM, in particular intravenous administration of BPs can lead to medication-related osteonecrosis of the jaws (MRONJ). [6] The diagnostic criteria for MRONJ include a history of bisphosphonate or antiresorptive usage, no history of radiotherapy, and the presentation of exposed or necrotic alveolar bone of maxilla or mandible for more than eight weeks with or without pain.…”

“…BPs are recommended as ongoing therapy for all myeloma patients with bone disease. According to "Myeloma Management Guidelines -Consensus Report from the Scientific Advisors of the International Myeloma Foundation" [7]; the bisphosphonates are in general use for MM are pamidronate, zoledronic acid, and clodronate. These medications have proven to be equivalent in reducing skeletal related events or bone complications, such as fractures and pain.…”