Caggiano Mario, Di Spirito Federica, Acerra Alfonso, Galdi Marzio, Sisalli Laura
Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Via Allende, 84081 Baronissi, Italy.
Dent J (Basel). 2023 Apr 13;11(4):104. doi: 10.3390/dj11040104.
A 60-year-old woman suffering from multiple myeloma (MM) was treated with zoledronic acid (bisphosphonate), dexamethasone (corticosteroid), bortezomib (a chemotherapeutic agent), and lenalidomide (thalidomide analog) for about a year and with lenalidomide alone as maintenance therapy for almost two years and developed stage three medication-related osteonecrosis of the jaws (MRONJ) in the upper left dental arch approximately two weeks after tooth extraction, which was treated with a medical nonoperative conservative approach until reversion to stage one. The present case report describing the development of multi-drug-related osteonecrosis of the jaws during the pharmacologic MM maintenance phase draws attention to the complex multidisciplinary and multistage management of MM subjects and also that during disease remission, crucially involving oral healthcare providers for MRONJ prevention and pharmacovigilance. To prevent similar cases, cancer patient management should ensure proper dental care not only before starting but also throughout therapy duration and ensure continuous interdisciplinary consensus between oncologists and dentists. Moreover, also considering the independent negative and potentially synergistic effect on bone metabolism and mucosal healing processes of employed medicaments, additionally combined with the cumulative one of previous intravenous bisphosphonates, further studies should highlight the polypharmacy effect and hopefully aid in patient-specific MRONJ risk assessment in cancer patients.
一名60岁的多发性骨髓瘤（MM）女性患者接受了唑来膦酸（双膦酸盐）、地塞米松（皮质类固醇）、硼替佐米（一种化疗药物）和来那度胺（沙利度胺类似物）治疗约一年，并单独使用来那度胺作为维持治疗近两年，在拔牙后约两周，左上牙弓出现了三级药物相关性颌骨坏死（MRONJ），采用非手术保守治疗方法直至恢复到一级。本病例报告描述了在MM药物维持阶段发生的多药相关性颌骨坏死，提请注意MM患者复杂的多学科和多阶段管理，以及在疾病缓解期间，至关重要的是要让口腔保健提供者参与MRONJ的预防和药物警戒。为防止类似病例发生，癌症患者管理不仅应在开始治疗前，而且在整个治疗期间确保适当的口腔护理，并确保肿瘤学家和牙医之间持续的跨学科共识。此外，考虑到所用药物对骨代谢和黏膜愈合过程的独立负面和潜在协同作用，再加上先前静脉注射双膦酸盐的累积作用，进一步的研究应突出多药联用的影响，并有望有助于对癌症患者进行个体化的MRONJ风险评估。
