Expert consensus on a multidisciplinary approach for the management of multiple myeloma-related bone disease

Yutong Wang¹, Qiming Xu², Yuan Li², Yongbin Su³, Ling Wang³, Xiaoquan Wang⁴, Jian Ge⁵, Hongmei Jing⁶, Yuxing Guo⁷, Yalin Chen⁸, Xianan Li⁸, Jun-Ling Zhuang⁹, Jing Tan¹⁰, Xiaobo Wang¹¹, Liye Zhong¹², Jun Luo¹³, Peng Zhao¹⁴, Shengjin Fan¹⁵, Jinhai Ren¹⁶, Haiping Yang¹⁷, Heng Mei¹⁸, Chunyan Sun¹⁸, Chunrui Li¹⁹, Xuemei Sun²⁰, Xuechun Lu²¹, Guangxun Gao²², Zeping Zhou²³, Yaozhu Pan²⁴, Ying Sun²⁵, Zhang Hong²⁶, Zhiqiang Liu²⁷, Yanping Ma²⁸, Yi Wang²⁹, Wei Sun³⁰, Jian Hou³¹, Jianqing Mi³², Wenming Chen³³, Xiaobing Huang³⁴, Bingzong Li³⁵, Rong Fu³⁶, Jumei Shi³⁷, Xuehong Ran³⁸, Fuling Zhou³⁹, Aili He⁴⁰, Min Mao⁴¹, Zhen Cai⁴², Nan Li⁴³, Meng Xu⁴³, Xiaojing Yan⁴⁴, Wei Yang⁴⁵, Gang An⁴⁶, Lihua Gong⁴⁷, Lichao Sun⁴⁸, Zhihong Li⁴⁹, Tang Liu⁴⁹, Yanjuan He⁵⁰, Junqiang Yin⁵¹, Yao Liu⁵², Weifeng Liu², Li Bao¹

Affiliations

¹ Department of Hematology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100031, China.
² Department of Orthopedic Oncology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100031, China.
³ Department of Radiology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100031, China.
⁴ Department of Rehabilitation, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100031, China.
⁵ Department of Hematology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230032, China.
⁶ Department of Hematology, Peking University Third Hospital, Beijing 100191, China.
⁷ Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China.
⁸ Department of Radiotherapy, Peking University People's Hospital, Beijing 100044, China.
⁹ Department of Hematology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
¹⁰ Department of Hematology, The Third People's Hospital of Chengdu, Chengdu, Sichuan 610031, China.
¹¹ Department of Hematology, The Second Hospital of Dalian Medical University, Dalian, Liaoning 116023, China.
¹² Department of Hematology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong 510080, China.
¹³ Department of Hematology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, China.
¹⁴ Department of Hematology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550004, China.
¹⁵ Department of Hematology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150000, China.
¹⁶ Department of Hematology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050017, China.
¹⁷ Department of Hematology, The First Affiliated Hospital, Henan University of Science and Technology, Luoyang, Henan 471000, China.
¹⁸ Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China.
¹⁹ Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China.
²⁰ Division of Hematology, Department of Medicine, Jiangsu Provincial Traditional Chinese Medical Hospital, Nanjing, Jiangsu 210023, China.
²¹ Department of Hematology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing 100853, China.
²² Department of Hematology, Xijing Hospital, Air Force Military Medical University, Xi'an, Shaanxi 710032, China.
²³ Department of Hematology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650504, China.
²⁴ Department of Hematology, The 940th Hospital of Joint Logistics Support Force of Chinese PLA, Lanzhou, Gansu 730050, China.
²⁵ Department of Hematology, Chifeng Municipal Hospital, Chifeng, Nei Monggol 024000, China.
²⁶ Department of Hematology, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, Shandong 271000, China.
²⁷ Shandong Provincial Key Laboratory of Radiation Oncology, Cancer Research Center, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, China.
²⁸ Department of Hematology, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi 030001, China.
²⁹ Department of Hematology, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi 710068, China.
³⁰ Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China.
³¹ Department of Hematology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China.
³² Department of Hematology, Shanghai Institute of Hematology, National Research Center for Translational Medicine, State Key Laboratory of Medical Genomics, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
³³ Department of Hematology, Myeloma Research Center of Beijing, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China.
³⁴ Department of Hematology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan 610072, China.
³⁵ Department of Hematology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, China.
³⁶ Department of Hematology, Tianjin Medical University General Hospital, Tianjin 300052, China.
³⁷ Department of Hematology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200123, China.
³⁸ Department of Hematology, Weifang People's Hospital, The First Affiliated Hospital of Weifang Medical University, Weifang, Shandong 261041, China.
³⁹ Department of Hematology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, China.
⁴⁰ Department of Hematology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710004, China.
⁴¹ Department of Hematology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang Uygur Autonomous Region 830001, China.
⁴² Bone Marrow Transplantation Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310000, China.
⁴³ Department of Orthopedics, Forth Medical Center of PLA General Hospital 100048, Beijing, China.
⁴⁴ Department of Hematology, First Hospital of China Medical University, Shenyang, Liaoning 110001, China.
⁴⁵ Department of Hematology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110055, China.
⁴⁶ State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China.
⁴⁷ Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
⁴⁸ State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
⁴⁹ Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China.
⁵⁰ Department of Hematology, Xiangya Hospital, Central South University, Changsha, Hunan 410078, China.
⁵¹ Department of Musculoskeletal Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, China.
⁵² Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing 400044, China.

PMID: 40697511
PMCID: PMC12277822
DOI: 10.1016/j.cpt.2024.12.002

Expert consensus on a multidisciplinary approach for the management of multiple myeloma-related bone disease

Yutong Wang et al. Cancer Pathog Ther. 2024.

. 2024 Dec 18;3(4):280-292.

doi: 10.1016/j.cpt.2024.12.002. eCollection 2025 Jul.

Authors

Affiliations

¹ Department of Hematology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100031, China.
² Department of Orthopedic Oncology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100031, China.
³ Department of Radiology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100031, China.
⁴ Department of Rehabilitation, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100031, China.
⁵ Department of Hematology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230032, China.
⁶ Department of Hematology, Peking University Third Hospital, Beijing 100191, China.
⁷ Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China.
⁸ Department of Radiotherapy, Peking University People's Hospital, Beijing 100044, China.
⁹ Department of Hematology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
¹⁰ Department of Hematology, The Third People's Hospital of Chengdu, Chengdu, Sichuan 610031, China.
¹¹ Department of Hematology, The Second Hospital of Dalian Medical University, Dalian, Liaoning 116023, China.
¹² Department of Hematology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong 510080, China.
¹³ Department of Hematology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, China.
¹⁴ Department of Hematology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550004, China.
¹⁵ Department of Hematology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150000, China.
¹⁶ Department of Hematology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050017, China.
¹⁷ Department of Hematology, The First Affiliated Hospital, Henan University of Science and Technology, Luoyang, Henan 471000, China.
¹⁸ Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China.
¹⁹ Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China.
²⁰ Division of Hematology, Department of Medicine, Jiangsu Provincial Traditional Chinese Medical Hospital, Nanjing, Jiangsu 210023, China.
²¹ Department of Hematology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing 100853, China.
²² Department of Hematology, Xijing Hospital, Air Force Military Medical University, Xi'an, Shaanxi 710032, China.
²³ Department of Hematology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650504, China.
²⁴ Department of Hematology, The 940th Hospital of Joint Logistics Support Force of Chinese PLA, Lanzhou, Gansu 730050, China.
²⁵ Department of Hematology, Chifeng Municipal Hospital, Chifeng, Nei Monggol 024000, China.
²⁶ Department of Hematology, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, Shandong 271000, China.
²⁷ Shandong Provincial Key Laboratory of Radiation Oncology, Cancer Research Center, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, China.
²⁸ Department of Hematology, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi 030001, China.
²⁹ Department of Hematology, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi 710068, China.
³⁰ Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China.
³¹ Department of Hematology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China.
³² Department of Hematology, Shanghai Institute of Hematology, National Research Center for Translational Medicine, State Key Laboratory of Medical Genomics, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
³³ Department of Hematology, Myeloma Research Center of Beijing, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China.
³⁴ Department of Hematology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan 610072, China.
³⁵ Department of Hematology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, China.
³⁶ Department of Hematology, Tianjin Medical University General Hospital, Tianjin 300052, China.
³⁷ Department of Hematology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200123, China.
³⁸ Department of Hematology, Weifang People's Hospital, The First Affiliated Hospital of Weifang Medical University, Weifang, Shandong 261041, China.
³⁹ Department of Hematology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, China.
⁴⁰ Department of Hematology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710004, China.
⁴¹ Department of Hematology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang Uygur Autonomous Region 830001, China.
⁴² Bone Marrow Transplantation Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310000, China.
⁴³ Department of Orthopedics, Forth Medical Center of PLA General Hospital 100048, Beijing, China.
⁴⁴ Department of Hematology, First Hospital of China Medical University, Shenyang, Liaoning 110001, China.
⁴⁵ Department of Hematology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110055, China.
⁴⁶ State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China.
⁴⁷ Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
⁴⁸ State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
⁴⁹ Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China.
⁵⁰ Department of Hematology, Xiangya Hospital, Central South University, Changsha, Hunan 410078, China.
⁵¹ Department of Musculoskeletal Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, China.
⁵² Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing 400044, China.

PMID: 40697511
PMCID: PMC12277822
DOI: 10.1016/j.cpt.2024.12.002

Abstract

This consensus on multiple myeloma-related bone diseases (MBDs) underscores the importance of a multidisciplinary approach that encompasses hematology, radiology, orthopedics, and additional specialties to tackle its intricate challenges. MBD, a prevalent and debilitating complication of multiple myeloma, leads to bone pain, fractures, and skeletal-related events (SREs), which profoundly impact patients' quality of life. The guidelines offer a thorough framework for diagnosis, treatment, and continual assessment, emphasizing early detection and consistent monitoring using imaging techniques such as positron emission tomography-computed tomography (PET-CT) and magnetic resonance imaging (MRI). Treatment strategies prioritize the careful application of anti-myeloma agents, bisphosphonates, and denosumab to minimize bone loss and decrease SRE risk, complemented by surgical and radiotherapy interventions for structural or pain-related issues. Supportive care measures, including pain management, rehabilitation, nutritional support, and dental evaluations, play a crucial role in enhancing patient outcomes and preserving quality of life. This consensus advocates a standardized, evidence-based approach to managing MBD, ensuring comprehensive and coordinated care for patients.

Keywords: Bone disease; Diphosphonates; Multiple myeloma; Orthopedics; Quality of life; Recommendation; Therapeutic effect.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

**Figure 1**
Mannequin representation illustrating the incidence of bone lesions across different skeletal sites in patients with MBD. MBD: Myeloma-related bone disease.

**Figure 2**
Epidural Spinal Cord Compression grading scale. CT: Computed tomography; FDG: Fluorodeoxyglucose; MBD: Myeloma-related bone disease; MRI: Magnetic resonance imaging; PET: Positron emission tomography.

**Figure 3**
Imaging algorithm for multiple myeloma patients with myeloma-related bone disease. In the absence of advanced imaging modalities, localized computed tomography examinations, including imaging of the long bones, serve as an acceptable alternative. CT: Computed tomography; FDG: Fluorodeoxyglucose; MBD: Myeloma-related bone disease; MM: Multiple myeloma; MRI: Magnetic resonance imaging; PET: Positron emission tomography.

See this image and copyright information in PMC

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Expert consensus on a multidisciplinary approach for the management of multiple myeloma-related bone disease

Affiliations

Expert consensus on a multidisciplinary approach for the management of multiple myeloma-related bone disease

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

LinkOut - more resources

Full Text Sources