Advances in Supportive Care for Multiple Myeloma-Related Bone Disease-A Review

Abstract

Multiple myeloma (MM) is an incurable plasma cell malignancy characterized by the increased production of monoclonal immunoglobulin. Patients with MM are at high risk of suffering from disease-related complications. Osteolytic bone disease is one of the most common disease-related complications, resulting in chronic pain and skeletal pathologies that contribute significantly to high morbidity and mortality rates among MM patients. In addition to standard anti-MM therapy, management of disease-related sequelae is integral to improving quality of life in MM patients. Bisphosphates have long been the mainstay treatment for patients with myeloma bone disease (MBD) due to their ability to reduce the incidence of skeletal-related adverse events. However, in recent years, a deeper understanding of the complex biology and pathophysiology associated with myeloma bone disease has led to the development of novel therapies that have the potential to improve MM patient management and outcomes. This narrative review uses the most recent extant publications to review all such advancements. It aims to summarize evidence-based strategies for the management of myeloma bone disease and therapy-associated adverse events whilst highlighting current guidelines on optimal bisphosphonate use and providing an overview of promising new agents currently in clinical development.

Keywords: bone pain; myeloma bone disease; myeloma bone pain; palliative care; supportive care.

Figure 1

Therapeutic approach to bone disease and complications in multiple myeloma: a clinical management algorithm.