Updated guidelines in the treatment of myeloma bone disease in 2025: consensus statement by the Medical and Scientific advisory group of Australia (MSAG) to myeloma australia.
Angelina Yong, Kate Vandyke, Bradley Augustson, Georgia McCaughan, Dipti Talaulikar, Ferenc Szabo, Henry Miles Prince, Phoebe Joy Ho, Hang Quach, Simon J Harrison, Cindy Hs Lee
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引用次数: 0
Abstract
Introduction: Multiple myeloma is a hematological malignancy characterized by clonal plasma cells proliferation within the bone marrow, often resulting in osteolytic bone disease. Traditionally, bisphosphonates such as zoledronic acid and pamidronate, have been used in the prophylaxis and treatment of myeloma bone disease (MBD).
Areas covered: A comprehensive, systematic review using these key words, 'multiple myeloma,' 'myeloma bone disease,' 'bisphosphonates,' 'denosumab,' 'osteonecrosis' was conducted on Medline and Cochrane databases from 1995 to 2024. Priority was given to randomized, double-blinded clinical trials; with inclusion oflarge case cohort studies in view of the limited comparison between different bone resorptive agents in the treatment of myeloma bone disease.
Expert opinion: This updated guideline recommends a two-year course of bisphosphonates treatment, with suggested extension of dosing intervals if the disease remains stable.Denosumab, a monoclonal antibody targeting receptor activator of nuclear factor **B ligand (RANKL), has demonstrated efficacy and non-inferiority compared to zoledronic acid in the treatment of MBD and may serve as an alternative treatment option especially with renal impairment. Further research into the utility of bone turnover markers for guiding anti-resorptive therapy in myeloma bone disease may provide significant clinical benefit. In addition, therapeutic strategies aimed at enhancing osteoblastic activity represent a potential therapeutic strategy.
期刊介绍：
Advanced molecular research techniques have transformed hematology in recent years. With improved understanding of hematologic diseases, we now have the opportunity to research and evaluate new biological therapies, new drugs and drug combinations, new treatment schedules and novel approaches including stem cell transplantation. We can also expect proteomics, molecular genetics and biomarker research to facilitate new diagnostic approaches and the identification of appropriate therapies. Further advances in our knowledge regarding the formation and function of blood cells and blood-forming tissues should ensue, and it will be a major challenge for hematologists to adopt these new paradigms and develop integrated strategies to define the best possible patient care. Expert Review of Hematology (1747-4086) puts these advances in context and explores how they will translate directly into clinical practice.
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