Dr. Brian Durie, Dr. Keith Stewart and Dr. David Vesole all answered questions about bone involvement in multiple myeloma at last week’s IMF conference I attended in Edina, Minnesota, just south of Minneapolis. In addition, Dr. Durie gave a one hour presentation, “Bone Disease In Myeloma.” I will spend the next two days touching on key points of Dr. Durie’s presentation:
1) There is no correlation between whether or not myeloma cells are sensitive to treatment and the speed or extent of bone involvent.
2) 80% of myeloma patients have lytic bone lesions or diffuse osteoporosis.
3) MRI’s, CT and PET scans are more effective ways of determining month to month changes than x-rays. Dr. Durie recommends using one or more of these tests, in addition to x-rays, as a bench mark, then re-taking the tests as often as every four to six months when active myeloma is present.
4) Remember these tests will lag behind clinical response.
5) Treatment for bone disease include chemotherapy and radiation to stop the myeloma. Treatment of the patient’s bone involvement should include bisphosphonates, calcium and vitamin D, supportive care and, if necessary, kyphoplasty or vertebroplasty.
6) Overall strategies when dealing with bone damage in myeloma patients include diagnosing and monitoring bone disease, taking bisphosphonates, exercise, not being afraid to use pain relief and avoiding risky situations like heavy lifting and walking on snow and ice.
Tomorrow let’s take a more detailed look at how specific drugs can help improve and prevent future bone damage. Feel good, keep smiling and don’t go sky-diving or play hockey after you have been diagnosed with advanced myeloma, OK? Pat