Impact of treatment delay of multiple myeloma bone disease on later myeloma-related skeletal events and outcome

IF 3.4 2区医学 Q2 Medicine

Journal of Bone Oncology Pub Date : 2025-06-07 DOI:10.1016/j.jbo.2025.100693

Eskelinen Veera , Niemi Pauli , Partanen Anu , Kangas Jaakko , E.L.Kuusisto Milla

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Abstract

Limited data exists on the effect of treatment delay of multiple myeloma (MM) bone disease on the disease course. In this real-world analysis of 625 patients with newly diagnosed MM (NDMM) we aimed to investigate the impact of delay in starting bone disease treatment on later skeletal events and outcome.

Altogether 480 (76.8 %) patients had bone disease at the diagnosis, 282 (45.1 %) patients had a fracture at diagnosis, and 181 (29.1 %) patients had a later fracture during the follow-up. A delay in the initiation of treatment of bone disease was experienced by 221 (35.4 %) patients and tooth extraction was a main reason for the delay. Patients with a delay seemed to experience earlier and more frequent later fractures. Also, a fracture (p = 0.003) or bone disease (p < 0.001) at diagnosis predicted earlier incidence of later fractures. As a bone targeted treatment, altogether 363 (58.1 %) patients received zoledronic acid, 81 (13.0 %) denosumab and 134 (21.4 %) other bone-targeted treatment. Patients treated with denosumab had poorer overall survival (OS) (p < 0.001) and experienced earlier later fractures (p = 0.003). Multivariate analysis showed that bone disease at diagnosis (p = 0.043) and given bone disease treatment (p = 0.023) significantly impacted on the time to next fracture. Regarding OS, delay in osteoprotective treatment (p = 0.004) and time of the diagnosis (p < 0.001) were significant factors in multivariate analysis.

To conclude, this study suggests that early initiation of bone disease treatment seemed to prevent later fractures. These findings highlight the importance of patients’ rapid access to a dentist and the start of bone targeted treatment without delay after a myeloma diagnosis.

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多发性骨髓瘤骨病治疗延迟对后期骨髓瘤相关骨骼事件和结果的影响

关于多发性骨髓瘤（MM）骨病治疗延迟对病程影响的资料有限。在这项对625名新诊断MM （NDMM）患者的现实分析中，我们旨在研究延迟开始骨病治疗对后来骨骼事件和结果的影响。共有480例（76.8%）患者在诊断时患有骨病，282例（45.1%）患者在诊断时发生骨折，181例（29.1%）患者在随访期间发生骨折。221例（35.4%）骨病患者延迟开始治疗，拔牙是延迟的主要原因。延迟的患者似乎经历了更早和更频繁的骨折。此外，骨折（p = 0.003）或骨病(p <；0.001)，可预测较早的骨折发生率。作为骨靶向治疗，363例（58.1%）患者接受了唑来膦酸治疗，81例（13.0%）接受了地诺单抗治疗，134例（21.4%）接受了其他骨靶向治疗。接受denosumab治疗的患者总生存期（OS）较差(p <；0.001)，且骨折时间较早，骨折时间较晚（p = 0.003）。多因素分析显示，诊断时骨病（p = 0.043）和给予骨病治疗（p = 0.023）对下一次骨折时间有显著影响。对于OS，保骨治疗延迟（p = 0.004）和诊断时间(p <；0.001)是多变量分析的显著因素。总之，这项研究表明，尽早开始骨病治疗似乎可以预防后来的骨折。这些发现强调了患者在骨髓瘤诊断后迅速就医和立即开始骨靶向治疗的重要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Bone Oncology ONCOLOGY-

CiteScore

7.20

自引率

2.90%

发文量

审稿时长

34 days

期刊介绍： The Journal of Bone Oncology is a peer-reviewed international journal aimed at presenting basic, translational and clinical high-quality research related to bone and cancer. As the first journal dedicated to cancer induced bone diseases, JBO welcomes original research articles, review articles, editorials and opinion pieces. Case reports will only be considered in exceptional circumstances and only when accompanied by a comprehensive review of the subject. The areas covered by the journal include: Bone metastases (pathophysiology, epidemiology, diagnostics, clinical features, prevention, treatment) Preclinical models of metastasis Bone microenvironment in cancer (stem cell, bone cell and cancer interactions) Bone targeted therapy (pharmacology, therapeutic targets, drug development, clinical trials, side-effects, outcome research, health economics) Cancer treatment induced bone loss (epidemiology, pathophysiology, prevention and management) Bone imaging (clinical and animal, skeletal interventional radiology) Bone biomarkers (clinical and translational applications) Radiotherapy and radio-isotopes Skeletal complications Bone pain (mechanisms and management) Orthopaedic cancer surgery Primary bone tumours Clinical guidelines Multidisciplinary care Keywords: bisphosphonate, bone, breast cancer, cancer, CTIBL, denosumab, metastasis, myeloma, osteoblast, osteoclast, osteooncology, osteo-oncology, prostate cancer, skeleton, tumour.