Long-term outcome following vertebroplasty or bone cementoplasty in multiple myeloma patients.

Abstract

Objective: Evaluating long-term outcomes following cementoplasty in patients with multiple myeloma (MM).

Methods: This is a single-center, retrospective study on all cementoplasties performed between January 2012 and December 2017. Patients with MM with a control MRI or CT scan beyond 5 years after the procedure were included. Images were reviewed blinded to the patients' clinical status.

Results: During the inclusion period, 2085 patients underwent cementoplasty, including 154 patients with MM. Forty-seven patients (33 men (70%); median age 62.2 years [IQR 53.8;69.6]) were included. The patients underwent 74 procedures (142 cemented sites: 129 vertebrae, 11 pelvic girdle cementoplasties, and 2 other sites; 101 (71%) demineralized fractures and 41 (29%) osteolytic lacunae). No serious procedure-related adverse effects were observed. Only 2 (1.4%) recurrent fractures of the cemented bone were observed. At-risk adjacent vertebrae were defined as non-cemented vertebrae, adjacent to a cemented vertebra: 15/109 (14%) fractures of at-risk adjacent vertebrae were documented during follow-up (15/99 [15%] after excluding cervical at-risk vertebrae). Intervertebral disc cement leakage was significantly associated with the occurrence of vertebral fracture at the adjacent level (31% vs. 8.8%, p = 0.022). Fourteen patients (30%) developed a new vertebral fracture that was remote from the cemented site. These were more frequent in patients with higher bone marrow plasmacytosis (median 23% vs. 13%, p = 0.014), relapsed multiple myeloma (86% vs. 55%, p = 0.042) and bone demineralization fractures (93% vs. 48%, p < 0.01).

Conclusion: Bone cementoplasty for MM is a durable treatment. At-risk adjacent vertebra fracture is a frequent event, prompting a discussion on prophylactic adjacent-level cementoplasty.