IMWG recommendations for the treatment of multiple myeloma-related bone disease
This paper, written by an interdisciplinary panel of experts in myeloma and myeloma bone disease, reviews the available evidence and provides recommendations for the management of myeloma-related bone disease.
Based on a comprehensive review and the GRADE evaluation method, these guidelines recommend zoledronic acid as the preferred bone-targeted treatment for newly diagnosed patients, whether or not bone disease is present. Once a significant treatment response is achieved, the frequency of zoledronic acid may be reduced.
Denosumab is also suggested, particularly for patients with renal impairment, though its discontinuation can be challenging due to a rebound effect. For painful vertebral fractures, cement augmentation is effective, while radiotherapy is recommended for uncontrolled pain and certain spinal issues. Surgery is advised for managing pathological fractures, spinal instability, and spinal cord compression.
These guidelines aim to optimise the management of bone disease in multiple myeloma, improving patient outcomes and quality of life.
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