1 Department of Diagnostic Radiology, Eberhard Karls University, Hoppe-Seyler-Strasse 3, 72076 Tübingen, Germany.
AJR Am J Roentgenol. 2014 Jan;202(1):170-9. doi: 10.2214/AJR.12.10367.
The objective of our study was to assess the frequency, location, extent, and patterns of bone sclerosis occurring in patients with multiple myeloma (MM) during bortezomib-based therapy.
From June 2003 through December 2011, 593 whole-body reduced-dose MDCT studies were performed of 79 consecutive patients receiving bortezomib. The median surveillance time was 21 months (range, 3-67 months). Baseline studies were compared with follow-up studies during therapy (follow-up 1), at the end of therapy (follow-up 2), and 12 months after cessation of bortezomib therapy (follow-up 3). We recorded any sclerotic change occurring inside or along the margins of the osteolytic lesions, in the cancellous bone, or inside preexistent medullary or extramedullary lesions. The time point of occurrence of bone sclerosis was correlated with the best hematologic response category.
Fourteen (17.7%) patients developed focal (n = 11) or diffuse (n = 3) bone sclerosis. The time window from bortezomib initiation to radiographic detection of bone sclerosis was 8 months (SD, 7 months). Sclerosis occurred at multiple sites (n = 7) or at an isolated site (n = 7). On subsequent whole-body reduced-dose MDCT studies, sclerosis further increased in seven (50%) patients. Hematologic best response during bortezomib treatment was complete response (n = 1), very good partial response (n = 2), partial response (n = 8), and stable disease (n = 3). Radiologic response at the time of sclerosis detection was partial response (n = 8), stable disease (n = 2), and progressive disease (n = 4).
Bone remineralization may occur during bortezomib-based therapy for MM in a substantial proportion of patients. The extent, location, and patterns of sclerosis differ among patients and are unpredictable. Sclerosis was documented even in patients showing suboptimal hematologic response.
本研究旨在评估接受硼替佐米治疗的多发性骨髓瘤（MM）患者中骨硬化的频率、部位、程度和模式。
2003 年 6 月至 2011 年 12 月，对 79 例连续接受硼替佐米治疗的患者进行了 593 次全身低剂量 MDCT 检查。中位随访时间为 21 个月（范围 3-67 个月）。将基线研究与治疗期间的随访研究（随访 1）、治疗结束时的随访研究（随访 2）和硼替佐米治疗停止后 12 个月的随访研究（随访 3）进行比较。我们记录了在溶骨性病变内部或沿其边缘、松质骨内或原有髓内或髓外病变内发生的任何硬化性改变。骨硬化的发生时间与最佳血液学反应类别相关。
14 例（17.7%）患者出现局灶性（n=11）或弥漫性（n=3）骨硬化。从硼替佐米开始到放射学检测到骨硬化的时间窗为 8 个月（标准差为 7 个月）。硬化发生在多个部位（n=7）或单个部位（n=7）。在随后的全身低剂量 MDCT 研究中，7 例（50%）患者的硬化进一步增加。硼替佐米治疗期间的血液学最佳反应为完全缓解（n=1）、非常好的部分缓解（n=2）、部分缓解（n=8）和稳定疾病（n=3）。在检测到硬化时的影像学反应为部分缓解（n=8）、稳定疾病（n=2）和进展性疾病（n=4）。
在接受硼替佐米治疗的 MM 患者中，相当一部分患者可能会出现骨再矿化。硬化的程度、部位和模式在患者之间存在差异，且不可预测。即使在血液学反应不理想的患者中，也记录到了硬化。
