What are the International Myeloma Working Group (IMWG) practice treatment guidelines for bone disease associated with multiple myeloma (MM)?

Updated: May 11, 2021
  • Author: Dhaval Shah, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

In 2021, the International Myeloma Working Group (IMWG) released updated practice guidelines for the management of multiple myeloma–related bone disease. [50]  The recommendations include the following:

  • Zoledronic acid is the preferred bone-targeted agent for patients with newly diagnosed multiple myeloma, whether or not they have multiple myeloma–related bone disease. Once patients achieve a very good partial response or better, after at least 12 months, consideration can be given to decreasing the frequency of zoledronic acid treatment or discontinuing it.
  • Denosumab can be considered for the treatment of multiple myeloma–related bone disease, particularly in patients with renal impairment. Denosumab might prolong progression-free survival in patients with newly diagnosed multiple myeloma who have multiple myeloma-related bone disease and who are eligible for autologous stem cell transplantation. Denosumab discontinuation is challenging due to the rebound effect.
  • Cement augmentation is effective for painful vertebral compression fractures.
  • Radiotherapy is recommended for uncontrolled pain, impending or symptomatic spinal cord compression, or pathologic fractures.
  • Surgery should be used for the prevention and restoration of long-bone pathologic fractures, vertebral column instability, and spinal cord compression with bone fragments within the spinal route.

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