Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
Br J Haematol. 2021 Jun;193(6):1034-1043. doi: 10.1111/bjh.17256. Epub 2020 Nov 29.
Bone-modifying therapies are essential in the treatment of patients with multiple myeloma. Zoledronic acid is preferred over other bisphosphonates due to its superiority in reducing the incidence of skeletal-related events and improving survival. The anti-receptor activator of nuclear factor-κΒ ligand (RANKL)-targeted agent denosumab has shown its non-inferiority compared to bisphosphonates in preventing skeletal-related events among newly diagnosed patients with myeloma bone disease. Denosumab may confer a survival benefit in patients eligible for autologous transplantation. Denosumab may present a safer profile for patients with renal impairment. Discontinuation of bone-directed therapies can be considered for patients with deep responses and after an adequate time period on treatment; however, a rebound effect may become evident especially in the case of denosumab. Three-monthly infusions of zoledronic acid or at-home denosumab administration should be considered during the coronavirus disease 2019 (COVID-19) pandemic. Measures to prevent hypocalcaemia, renal toxicity and osteonecrosis of the jaw are important for all bone-modifying agents.
骨改良治疗对于多发性骨髓瘤患者的治疗至关重要。与其他双膦酸盐相比，唑来膦酸因其在降低骨骼相关事件发生率和改善生存方面的优势而被优先选用。抗核因子-κΒ配体（RANKL）靶向药物地舒单抗在预防新诊断的骨髓瘤骨病患者的骨骼相关事件方面显示出与双膦酸盐的非劣效性。地舒单抗可能为有自体移植资格的患者带来生存获益。地舒单抗可能为肾功能受损的患者提供更安全的治疗方案。对于深度缓解的患者和经过充分治疗时间的患者，可以考虑停止骨靶向治疗；然而，特别是在使用地舒单抗的情况下，可能会出现反弹效应。在 2019 冠状病毒病（COVID-19）大流行期间，应考虑每 3 个月输注唑来膦酸或在家中使用地舒单抗进行治疗。预防低钙血症、肾毒性和颌骨坏死是所有骨改良药物的重要措施。
