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Karimi H, Sastry RA, Shao B, Abdulrazeq H, Li X, Niu T. Management of atraumatic chin-on-chest deformity in newly diagnosed multiple myeloma: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2024; 8:CASE2441. [PMID: 39622040 PMCID: PMC11616146 DOI: 10.3171/case2441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 09/25/2024] [Indexed: 12/06/2024]
Abstract
BACKGROUND Patients with multiple myeloma (MM) are commonly managed by multidisciplinary oncology teams in concordance with the neurological, oncological, mechanical, and systematic decision framework. Surgery is indicated for mechanical instability and/or neurological deficits. In neurologically intact and mechanically stable patients, chemo- and radiotherapy alone are often the mainstay treatment. OBSERVATIONS A 66-year-old male patient presented with a kyphotic chin-on-chest deformity due to undiagnosed spinal MM. He experienced progressive neck pain and difficulty with activities of daily living (ADLs). Imaging revealed systematic bony element destruction and burst deformities at T1-2 with cervicothoracic central canal stenosis. Due to his disease burden and neurological preservation, spinal alignment was initially achieved via halo traction and immobilization, allowing him to begin systemic therapy almost immediately after diagnosis and improving vertebral bone density and construct integrity prior to surgery. He underwent C2-T10 decompression and instrumented fusion with cement augmentation. At 12 months postoperatively, the patient reported improvement in symptomology and ADLs without radiographic evidence of hardware failure or spinal instability. LESSONS Spinal MM with instability can be successfully managed with gradual deformity realignment and external orthosis before surgery in a neurologically intact patient with a significant disease burden. https://thejns.org/doi/10.3171/CASE2441.
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Affiliation(s)
- Helen Karimi
- Department of Neurosurgery, Rhode Island Hospital, Warren Alpert School of Medicine at Brown University, Providence, Rhode Island
- Tufts University School of Medicine, Boston, Massachusetts
| | - Rahul A. Sastry
- Department of Neurosurgery, Rhode Island Hospital, Warren Alpert School of Medicine at Brown University, Providence, Rhode Island
| | - Belinda Shao
- Department of Neurosurgery, Rhode Island Hospital, Warren Alpert School of Medicine at Brown University, Providence, Rhode Island
| | - Hael Abdulrazeq
- Department of Neurosurgery, Rhode Island Hospital, Warren Alpert School of Medicine at Brown University, Providence, Rhode Island
| | - Xun Li
- Department of Neurosurgery, Jamaica Hospital Medical Center, Queens, New York
| | - Tianyi Niu
- Department of Neurosurgery, Rhode Island Hospital, Warren Alpert School of Medicine at Brown University, Providence, Rhode Island
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Liu JP, Yao XC, Wu Y, Xu ZY, Li M, Shi M, Ren J, Du XR. Analysis of the efficacy of separation surgery for severe neurological compression in multiple myeloma: a retrospective analysis of 35 cases. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:4292-4301. [PMID: 38647604 DOI: 10.1007/s00586-024-08269-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 04/04/2024] [Accepted: 04/08/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE To investigate the effectiveness and safety of separation surgery for Epidural Spinal Cord Compression (ESCC) graded ≥ 2 in patients with Multiple Myeloma (MM), analyze factors influencing surgical outcomes, and develop a preliminary treatment decision framework for these patients. METHODS A retrospective analysis was conducted on clinical data from 35 MM patients who underwent separation surgery for ESCC graded ≥ 2 between 2013 and 2018. Patient data, including baseline information, surgical details, complications, and pre-operative as well as one-month post-operative efficacy evaluation indicators were recorded. Statistical analysis was performed on pre-operative and post-operative efficacy indicators to determine if there were significant improvements (p < 0.05). Ordered logistic regression was utilized to assess factors associated with an unfavorable post-operative quality of life outcome. RESULTS Compared to pre-operative values, at one-month post-surgery, patients showed significant improvements in Frankel Score Classification (4 vs 5, p < 0.05), Karnofsky Performance Score (30 vs 70, p < 0.05), and Visual Analogue Scale (8 vs 3, p < 0.05). Complications occurred in 7 cases (20%). The number of segments with ESCC (OR = 0.171, p < 0.05) and pre-operative chemotherapy (OR = 5.202, p = 0.05) were identified as independent factors influencing patient outcomes. Patients with more than two vertebral segments with ESCC exhibited significantly worse post-operative conditions. CONCLUSIONS Separation surgery effectively alleviates pain, improves neurological function, and enhances the quality of life in patients with ESCC graded ≥ 2 due to MM.
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Affiliation(s)
- Jun-Peng Liu
- Department of Orthopaedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Xing-Chen Yao
- Department of Orthopaedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Yue Wu
- Department of Orthopaedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Zi-Yu Xu
- Department of Orthopaedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Meng Li
- Department of Orthopaedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Ming Shi
- Department of Orthopaedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Jie Ren
- Department of Orthopaedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Xin-Ru Du
- Department of Orthopaedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China.
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Liu JP, Xu ZY, Wu Y, Shi XJ, Shi M, Li M, Du XR, Yao XC. Which factors are associated with adverse prognosis in multiple myeloma patients after surgery? - preliminary establishment and validation of the nomogram. World J Surg Oncol 2024; 22:168. [PMID: 38918829 PMCID: PMC11202362 DOI: 10.1186/s12957-024-03453-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Accepted: 06/16/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND To investigate the prognosis of patients with Multiple Myeloma (MM) after surgery, analyze the risk factors leading to adverse postoperative outcomes, and establish a nomogram. METHODS Clinical data from 154 patients with MM who underwent surgery at our institution between 2007 and 2019 were retrospectively analyzed. Assessing and comparing patients' pain levels, quality of life, and functional status before and after surgery (P < 0.05) were considered statistically significant. The Kaplan-Meier survival curve was used to estimate the median survival time. Adverse postoperative outcomes were defined as worsened symptoms, lesion recurrence, complication grade ≥ 2, or a postoperative survival period < 1 year. Logistic regression analysis was used to determine the prognostic factors. Based on the logistic regression results, a nomogram predictive model was developed and calibrated. RESULTS Postoperative pain was significantly alleviated in patients with MM, and there were significant improvements in the quality of life and functional status (P < 0.05). The median postoperative survival was 41 months. Forty-nine patients (31.8%) experienced adverse postoperative outcomes. Multivariate logistic regression analysis identified patient age, duration of MM, International Staging System, preoperative Karnofsky Performance Status, and Hb < 90 g/L as independent factors influencing patient prognosis. Based on these results, a nomogram was constructed, with a C-index of 0.812. The calibration curve demonstrated similarity between the predicted and actual survival curves. Decision curve analysis favored the predictive value of the model at high-risk thresholds from 10% to-69%. CONCLUSION This study developed a nomogram risk prediction model to assist in providing quantifiable assessment indicators for preoperative evaluation of surgical risk.
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Affiliation(s)
- Jun-Peng Liu
- Department of Orthopaedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Zi-Yu Xu
- Department of Orthopaedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Yue Wu
- Department of Orthopaedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Xiang-Jun Shi
- Department of Rheumatology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Ming Shi
- Department of Orthopaedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Meng Li
- Department of Orthopaedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Xin-Ru Du
- Department of Orthopaedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China.
| | - Xing-Chen Yao
- Department of Orthopaedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
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Öztürk R, Amer K, Gençoğlu AT, Öztürk FG, Kasali K, Aytekin MN. Is surgical indication in multiple myeloma a poor prognosis sign? SEER database analysis. Clin Transl Oncol 2024; 26:524-531. [PMID: 37535183 DOI: 10.1007/s12094-023-03273-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 07/03/2023] [Indexed: 08/04/2023]
Abstract
AIM This study aims to investigate demographic data, survival rates, and the relationship of these rates with surgery in a large case series including multiple myeloma (MM) patients. METHOD MM cases were analyzed retrospectively using the latest version of the SEER database published in April 2020. This version covers January 1975 to December 2017. Patients were classified according to gender, age, and race/ethnicity. Tumors were classified according to their localization, grade, year of diagnosis, and follow-up results. RESULTS There were 60,239 patients diagnosed with Plasma Cell Myeloma. While 670 patients (1.2%) were operated on, 43,976 patients (76.7%) did not indicate operation, and 12,670 patients (22.1%) could not be operated on despite the recommendation. The mean survival was 62 months in those without an indication for surgery, and 42 months in patients with an indication but could not be operated on, and the difference was significant (p = 0.001). The mean survival was 58 months in the operated patients, and 42 months in the patients who could not be operated on despite the indication, and the difference was significant (p = 0.001). There was no difference between those who did not indicate surgery and those who were operated on with an indication (p = 0.243). CONCLUSION In multiple myeloma, the best prognosis is in the group of patients who received medical treatments without any indication for operation, while an indication for operation indicates a worse prognosis. A worse prognosis should be expected in patients who do not accept the operation or who cannot be operated on compared to the operated patients.
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Affiliation(s)
- Recep Öztürk
- Orthopedics and Traumatology, Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Demetevler Mahallesi, Vatan Cad., Yenimahalle, 06200, Ankara, Turkey.
| | - Kamil Amer
- Orthopedics, Rothman Orthopedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | | | | | - Kamber Kasali
- Department of Biostatistics, Atatürk University, Erzurum, Turkey
| | - Mahmut Nedim Aytekin
- Orthopedics and Traumatology, Ankara Yıldırım Beyazıt University, Ankara, Turkey
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Guedes A, Becker RG, Teixeira LEM. Multiple Myeloma (Part 2) - Update on The Approach to Bone Disease. Rev Bras Ortop 2023; 58:368-377. [PMID: 37396088 PMCID: PMC10310422 DOI: 10.1055/s-0043-1770150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 12/16/2022] [Indexed: 07/04/2023] Open
Abstract
The increase in life expectancy of the world population has led to a concomitant increase in the prevalence of multiple myeloma (MM), a disease that usually affects the elderly population. Bone lesions are frequent in patients with this condition, demanding an early approach, from drug treatment, through radiotherapy to orthopedic surgery (prophylactic or therapeutic) with the objective of preventing or delaying the occurrence of fracture, or, when this event has already occurred, treat it through stabilization or replacement (lesions located in the appendicular skeleton) and/or promote stabilization and spinal cord decompression (lesions located in the axial skeleton), providing rapid pain relief, return to ambulation and resocialization, returning quality of life to patients. The aim of this review is to update the reader on the findings of pathophysiology, clinical, laboratory and imaging, differential diagnosis and therapeutic approach of multiple myeloma bone disease (MMBD).
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Affiliation(s)
- Alex Guedes
- Grupo de Oncologia Ortopédica, Hospital Santa Izabel, Santa Casa de Misericórdia da Bahia, Salvador, BA, Brasil
| | - Ricardo Gehrke Becker
- Serviço de Trauma Ortopédico, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - Luiz Eduardo Moreira Teixeira
- Departamento do Aparelho Locomotor, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
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Divekar O, Ajayi B, Barkham B, Bernard J, Bishop T, Reyal Y, Willis F, Boyd K, Lui D, Coomber R. Chemotherapy May Obviate Prophylactic Femoral Nail Surgery for Multiple Myeloma Patients With High Mirels' Score Lesions and Impending Pathological Hip Fracture. Cureus 2023; 15:e37670. [PMID: 37206489 PMCID: PMC10189663 DOI: 10.7759/cureus.37670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2023] [Indexed: 05/21/2023] Open
Abstract
Bone involvement presents in >80% of patients with multiple myeloma. This causes lytic lesions for which prophylactic surgery is indicated to prevent pathological fractures if the lesion is graded ≥9/12 on Mirels' score. Although successful, these surgeries have risks and extended recovery periods. We present a case indicating myeloma chemotherapy may obviate prophylactic femoral nailing for high Mirels' score lesions in the femoral head with impending pathological hip fracture. A 72-year-old woman presented in December 2017 with back pain. A plain X-ray indicated degenerative anterolisthesis in her lumbosacral spine. Serum analysis revealed abnormal protein, globulin, alkaline phosphatase, and albumin levels while protein electrophoresis and serum immunofixation revealed raised immunoglobulin A (IgA) kappa paraprotein and kappa serum free light chains, respectively. Whole-body CT scans showed widespread lytic bone lesions and bone marrow biopsy confirmed infiltration by plasma cells. She was diagnosed with International Staging System (ISS) stage 3 multiple myeloma, which was successfully treated with bortezomib, thalidomide and dexamethasone with regular bisphosphonates that year. She presented again to the hospital in June 2020 with acute back and pelvic pain; Her paraprotein and serum-free light chains had increased significantly from her previous clinic appointment, indicating serological progression. MRI showed a relapse of the myeloma deposits in her right femoral head and spine. The deposit in her femoral head was graded 10/12 on Mirels' score, which indicated prophylactic femoral nailing. Instead, the patient was treated with daratumumab, bortezomib, and dexamethasone with escalation to monthly zoledronic acid infusions, as it was thought surgery would provide limited cytoreductive effect, preventing chemotherapy for six weeks post-surgery, potentiating pathological hip fracture and disease progression at other sites. This resulted in a complete response, thus reducing the deposits such that the femoral lesion was graded <8 on Mirels' score, improved her pain, and restored her ability to traverse stairs. She remains in complete response with ongoing daratumumab and denosumab maintenance treatment as of December 2022. Chemotherapy and bisphosphonates substantially reduced the myeloma deposit in the femoral head such that indications of prophylactic surgery were eliminated according to Mirels' score recommendations. This reduced the risk of pathological hip fracture whilst eliminating surgical complications. Further research should be conducted into the safety and efficacy of this treatment regimen in patients with high Mirels' score lesions. With this knowledge, consideration can be taken as to whether prophylactic femoral nailing is necessary given strong indications.
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Affiliation(s)
- Omkaar Divekar
- Trauma and Orthopaedics, St. George's University Hospital, London, GBR
| | - Bisola Ajayi
- Trauma and Orthopaedics, St. George's University Hospital, London, GBR
| | - Ben Barkham
- Orthopaedics, St. George's University Hospital, London, GBR
| | - Jason Bernard
- Complex Spinal Surgery, St. George's University Hospital, London, GBR
| | - Tim Bishop
- Complex Spinal Surgery, St. George's University Hospital, London, GBR
| | - Yasmin Reyal
- Hematology and Oncology, St. George's University Hospital, London, GBR
| | - Fenella Willis
- Hematology and Oncology, St. George's University Hospital, London, GBR
| | - Kevin Boyd
- Haematology, Royal Marsden Hospital, London, GBR
| | - Darren Lui
- Orthopaedics, St. George's Hospital, London, GBR
| | - Ross Coomber
- Trauma and Orthopaedics, St. George's University Hospital, London, GBR
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Shi X, Wei Y, Yao X, Du B, Wu X, Kong X, Du X. In vivo antitumor efficacy of 17-AAG loaded PMMA in a human multiple myeloma xenograft mouse model. Clin Exp Med 2023; 23:45-54. [PMID: 34989932 DOI: 10.1007/s10238-021-00786-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 12/13/2021] [Indexed: 11/26/2022]
Abstract
Multiple myeloma (MM) is a monoclonal malignancy characterized by abnormal proliferation of plasma cells. The disease clinically manifests as anemia, hypercalcemia, renal insufficiencies, and osteolytic damage. Osteolytic damage goes with severe bone pain, spinal instability, and pathological fracture, symptoms that are collectively referred to as multiple myeloma bone disease (MMBD). Polymethylmethacrylate (PMMA) bone cement is widely used for bone repair after MMBD surgery, owing to its excellent biomechanical properties and fast curing. To date, however, efficacy of drug-loading PMMA in inhibition of tumor growth and angiogenesis remains unknown. Here, we report that 17-AAG-loaded PMMA bone cement inhibits MM growth in vivo and suppresses tumor diffusion to peripheral tissues. In addition, 17-AAG-loaded PMMA promotes MM apoptosis by downregulating Bax and active Caspase-3.
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Affiliation(s)
- Xiangjun Shi
- Department of Hematology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100022, China
| | - Yanzhe Wei
- Department of Orthopedics, Shenzhen University General Hospital, Shenzhen, 518055, China
- Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100022, China
| | - Xingchen Yao
- Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100022, China
| | - Boran Du
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, 100026, China
| | - Xiaoguang Wu
- Department of Anatomy, Chengde Medical University, Hebei, 067000, China
| | - Xiangyu Kong
- Department of Anatomy, Chengde Medical University, Hebei, 067000, China
| | - Xinru Du
- Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100022, China.
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Charvátová S, Motais B, Czapla J, Cichoń T, Smolarczyk R, Walek Z, Giebel S, Hájek R, Bagó JR. Novel Local "Off-the-Shelf" Immunotherapy for the Treatment of Myeloma Bone Disease. Cells 2023; 12:cells12030448. [PMID: 36766789 PMCID: PMC9914109 DOI: 10.3390/cells12030448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/13/2023] [Accepted: 01/27/2023] [Indexed: 01/31/2023] Open
Abstract
Myeloma bone disease (MBD) is one of the major complications in multiple myeloma (MM)-the second most frequent hematologic malignancy. It is characterized by the formation of bone lesions due to the local action of proliferating MM cells, and to date, no effective therapy has been developed. In this study, we propose a novel approach for the local treatment of MBD with a combination of natural killer cells (NKs) and mesenchymal stem cells (MSCs) within a fibrin scaffold, altogether known as FINM. The unique biological properties of the NKs and MSCs, joined to the injectable biocompatible fibrin, permitted to obtain an efficient "off-the-shelf" ready-to-use composite for the local treatment of MBD. Our in vitro analyses demonstrate that NKs within FINM exert a robust anti-tumor activity against MM cell lines and primary cells, with the capacity to suppress osteoclast activity (~60%) within in vitro 3D model of MBD. Furthermore, NKs' post-thawing cytotoxic activity is significantly enhanced (~75%) in the presence of MSCs, which circumvents the decrease of NKs cytotoxicity after thawing, a well-known issue in the cryopreservation of NKs. To reduce the tumor escape, we combined FINM with other therapeutic agents (bortezomib (BZ), and tumor necrosis factor-related apoptosis-inducing ligand (TRAIL)), observing a clear therapeutic synergistic effect in vitro. Finally, the therapeutic efficacy of FINM in combination with BZ and TRAIL was assessed in a mouse model of MM, achieving 16-fold smaller tumors compared to the control group without treatment. These results suggest the potential of FINM to serve as an allogeneic "off-the-shelf" approach to improve the outcomes of patients suffering from MBD.
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Affiliation(s)
- Sandra Charvátová
- Department of Haematooncology, Faculty of Medicine, University of Ostrava, 70300 Ostrava, Czech Republic
- Faculty of Science, University of Ostrava, 70100 Ostrava, Czech Republic
- Department of Haematooncology, University Hospital Ostrava, 70800 Ostrava, Czech Republic
| | - Benjamin Motais
- Department of Haematooncology, Faculty of Medicine, University of Ostrava, 70300 Ostrava, Czech Republic
- Faculty of Science, University of Ostrava, 70100 Ostrava, Czech Republic
- Department of Haematooncology, University Hospital Ostrava, 70800 Ostrava, Czech Republic
| | - Justyna Czapla
- Center for Translational Research and Molecular Biology of Cancer, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44102 Gliwice, Poland
| | - Tomasz Cichoń
- Center for Translational Research and Molecular Biology of Cancer, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44102 Gliwice, Poland
| | - Ryszard Smolarczyk
- Center for Translational Research and Molecular Biology of Cancer, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44102 Gliwice, Poland
| | - Zuzana Walek
- Department of Haematooncology, Faculty of Medicine, University of Ostrava, 70300 Ostrava, Czech Republic
- Department of Haematooncology, University Hospital Ostrava, 70800 Ostrava, Czech Republic
| | - Sebastian Giebel
- Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44102 Gliwice, Poland
| | - Roman Hájek
- Department of Haematooncology, Faculty of Medicine, University of Ostrava, 70300 Ostrava, Czech Republic
- Department of Haematooncology, University Hospital Ostrava, 70800 Ostrava, Czech Republic
| | - Juli R. Bagó
- Department of Haematooncology, Faculty of Medicine, University of Ostrava, 70300 Ostrava, Czech Republic
- Department of Haematooncology, University Hospital Ostrava, 70800 Ostrava, Czech Republic
- Correspondence: ; Tel.: +42-(05)-97372092
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Ntontis Z, Koutserimpas C, Chaniotakis K, Stavrakakis I, Samonis G, Alpantaki K. Treatment of Pathological Fracture of Radius due to Multiple Myeloma with Elastic Intramedullary Nail and Cement Augmentation: Expanding the Indications of Elastic Nails. J Long Term Eff Med Implants 2023; 33:67-70. [PMID: 36734928 DOI: 10.1615/jlongtermeffmedimplants.2022044050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Pathological fractures of the proximal radius are exceedingly rare. Here, a case of an 81-year-old female diagnosed with multiple myeloma 15 years ago who suffered a pathological fracture of her left proximal radius is presented. Due to the fracture's proximity to the elbow joint and the lack of adjacent healthy bone tissue, a resourceful surgical intervention was implemented using a pediatric flexible nail supplemented by polymethacrylate cement injection. Six weeks post-operatively, the patient had alleviation of the pain with fully functional forearm. This novel approach could possibly aid in the treatment of other long bone pathological fractures due to neoplastic metastases.
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Affiliation(s)
- Zisis Ntontis
- Department of Orthopaedics and Traumatology, Venizeleion General Hospital of Heraklion, Crete, Greece
| | - Christos Koutserimpas
- Department of Orthopaedics and Traumatology, 251 Hellenic Air Force General Hospital of Athens, Greece
| | - Konstantinos Chaniotakis
- Department of Orthopaedics and Traumatology, Venizeleion General Hospital of Heraklion, Crete, Greece
| | - Ioannis Stavrakakis
- Department of Orthopaedics and Traumatology, Venizeleion General Hospital of Heraklion, Crete, Greece
| | - George Samonis
- Department of Medicine, University of Heraklion, Crete, Greece
| | - Kalliopi Alpantaki
- Department of Orthopaedics and Traumatology, Venizeleion General Hospital of Heraklion, Crete, Greece
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Choon-Quinones M, Hose D, Kaló Z, Zelei T, Harousseau JL, Durie B, Keown P, Barnett M, Jakab I. Patient and Caregiver Experience Decision Factors in Treatment Decision Making: Results of a Systematic Literature Review of Multiple Myeloma Decision Aids. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:39-49. [PMID: 35613958 DOI: 10.1016/j.jval.2022.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/18/2022] [Accepted: 04/08/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Decision-aids (DAs) may facilitate shared decision-making for patients and caregivers, by providing evidence-based information to assist healthcare professionals, patients, and caregivers in making choices about aspects of care, and/or highlighting decision factors to discuss with the potential of altering the treatment decision. These decision factors may not be well integrated in DAs. METHODS A systematic literature review was conducted in the field of multiple myeloma (MM) on peer-reviewed publications, extended with a gray literature search. Data on whether and how patient and caregiver experience elements, other than survival and physical quality of life, were mentioned as decision factors in the identified MM DAs were extracted and analyzed qualitatively. RESULTS Seventy MM DAs were found and analyzed; 51% of DAs mentioned any patient non-routinely assessed experience decision factors and only 17% mentioned any caregiver-related information. One hundred and forty potential decision factors were extracted, deduplicated and categorized into the following categories: 1) financial, 2) mode of administration / transportation issues, 3) personal beliefs and values, 4) emotional and social quality of life, 5) other medical information, 6) availability of social support, 7) caregiver burden. None of the DAs presented a comprehensive framework on all seven categories of decision factors being consider when mapping patient and caregiver experience value elements in MM. CONCLUSIONS Based on available DAs, we recommend a set of patient and caregiver experience decision factors that have the potential to affect treatment choices of patients with MM, which should be included in DAs, including MM clinical guidelines.
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Affiliation(s)
| | - Dirk Hose
- Vrije Universiteit Brussel, Brussels, Belgium
| | - Zoltán Kaló
- Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary; Syreon Research Institute, Budapest, Hungary
| | - Tamás Zelei
- Syreon Research Institute, Budapest, Hungary
| | | | - Brian Durie
- International Myeloma Foundation, Studio City, CA, USA
| | - Paul Keown
- University of British Columbia, Vancouver, BC, Canada
| | - Mike Barnett
- University of British Columbia, Vancouver, BC, Canada
| | - Ivett Jakab
- Syreon Research Institute, Budapest, Hungary
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11
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Xu ZY, Yao XC, Shi XJ, Du XR. Significance of preoperative peripheral blood neutrophil-lymphocyte ratio in predicting postoperative survival in patients with multiple myeloma bone disease. World J Clin Cases 2022; 10:4380-4394. [PMID: 35663088 PMCID: PMC9125285 DOI: 10.12998/wjcc.v10.i14.4380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 12/30/2021] [Accepted: 03/26/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The neutrophil-lymphocyte ratio (NLR) is often used to predict a poor prognosis in patients with tumors. This study investigated the preoperative peripheral blood NLR in predicting postoperative survival (POS) in patients with multiple myeloma bone disease (MMBD).
AIM To evaluate whether NLR can be used to predict the prognosis of MMBD patients after surgery.
METHODS The clinical data of 82 MMBD patients who underwent surgical treatments in Beijing Chao-yang Hospital were collected. The NLR was obtained from the absolute number of neutrophils and lymphocytes, calculated by the number of neutrophils and divided by the number of lymphocytes. The peripheral blood lymphocyte percentage was used as the major marker to analyze the change in characteristics of the immune statuses of multiple myeloma patients.
RESULTS The NLR cut-off values of NLR ≥ 3 patients and NLR ≥ 4 patients were significantly correlated with POS. The 3- and 5-year cumulative survival rates of the high NLR group (NLR ≥ 3 patients) were 19.1% and 0.0%, respectively, which were lower than those of the low NLR group (NLR < 3 patients) (67.2% and 48.3%) (P = 0.000). In the high NLR group, POS (14.86 ± 14.28) was significantly shorter than that in the low NLR group (32.68 ± 21.76). Univariate analysis showed that the lymphocyte percentage 1 wk after the operation (19.33 ± 9.08) was significantly lower than that before the operation (25.72 ± 11.02). Survival analysis showed that postoperative chemotherapy, preoperative performance status and preoperative peripheral blood NLR ≥ 3 were independent risk factors for POS.
CONCLUSION The preoperative peripheral blood NLR can predict POS in MMBD patients. MMBD patients with a high preoperative NLR (NLR ≥ 3) showed poor prognosis.
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Affiliation(s)
- Zi-Yu Xu
- Department of Orthopedics, Beijing Chao-Yang Hospital, Beijing 100020, China
| | - Xing-Chen Yao
- Department of Orthopedics, Beijing Chao-Yang Hospital, Beijing 100020, China
| | - Xiang-Jun Shi
- Department of Hematology, Beijing Chao-Yang Hospital, Beijing 100020, China
| | - Xin-Ru Du
- Department of Orthopedics, Beijing Chao-Yang Hospital, Beijing 100020, China
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12
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Yao XC, Shi XJ, Xu ZY, Tan J, Wei YZ, Qi L, Zhou ZH, Du XR. Preliminary establishment of a spinal stability scoring system for multiple myeloma. World J Clin Cases 2021; 9:9023-9037. [PMID: 34786385 PMCID: PMC8567514 DOI: 10.12998/wjcc.v9.i30.9023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 07/26/2021] [Accepted: 09/16/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Multiple myeloma is an incurable malignant plasma cell disorder that represents the most common primary malignant bone tumor. It commonly involves bone metastasis in multiple vertebral bodies, and the Spinal Instability Neoplastic Score scoring system may not be fully applicable to multiple myeloma (MM) patients.
AIM To evaluate the spinal stability of patients with MM spinal involvement to guide their clinical treatment.
METHODS By using the Delphi method, we collected and extracted information through a series of questionnaires and improved it via feedback. We also preliminarily established a spinal stability scoring system for multiple myeloma.
RESULTS Fifteen clinicians completed a second round of questionnaires and compared their answers with those of the first round of questionnaires to identify significant comments or changes that required group discussions. As a result, no further feedback was used to improve the scoring system. After integrating the information from the expert consultation questionnaire, we established the initial scoring system for MM spine stability and used the scoring system to assess a series of representative clinical cases. The MM spinal stability scoring system was created by calculating the scores of the six separate components: location, pain, number of segments, physiological curvature, comorbidities, and neurological function. The minimum value was “0”, and the maximum value was “24”. A score of “0–10” indicated “spine stability”, a score of “11–17” indicated “potential instability”, and a score of “18–24” indicated “spine instability”. Patients with a score of “11–24” need an intervention such as surgery.
CONCLUSION The initial establishment of the MM spine stability scoring system provides a vital theoretical basis for the evaluation of spine stability in individuals with MM.
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Affiliation(s)
- Xing-Chen Yao
- Department of Orthopedic, Beijing Chaoyang Hospital, Beijing 100020, China
| | - Xiang-Jun Shi
- Department of Hematology, Beijing Chaoyang Hospital, Beijing 100020, China
| | - Zi-Yu Xu
- Department of Orthopedic, Beijing Chaoyang Hospital, Beijing 100020, China
| | - Jie Tan
- Department of Hematology, Beijing Chaoyang Hospital, Beijing 100020, China
| | - Yan-Zhe Wei
- Department of Orthopedic, Beijing Chaoyang Hospital, Beijing 100020, China
| | - Lei Qi
- Department of Orthopedic, Beijing Chaoyang Hospital, Beijing 100020, China
| | - Zi-Hao Zhou
- Department of Orthopedic, Beijing Chaoyang Hospital, Beijing 100020, China
| | - Xin-Ru Du
- Department of Orthopedic, Beijing Chaoyang Hospital, Beijing 100020, China
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13
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Fliss E, Zaretski A, Cohen Y, Shapira Y, Gur E, Yanko R. Outside the box-Surgery for aggressive plasmacytoma in scar. Clin Case Rep 2021; 9:1325-1329. [PMID: 33768837 PMCID: PMC7981673 DOI: 10.1002/ccr3.3761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 07/25/2020] [Accepted: 07/28/2020] [Indexed: 11/26/2022] Open
Abstract
This report introduces the concept of large-scale surgery and reconstruction when all other medical means of treatment have failed. In select cases, this may act as a mode of buying time and allowing the patient to receive second- or third-line treatments.
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Affiliation(s)
- Ehud Fliss
- Department of Plastic SurgeryTel Aviv Sourasky Medical CenterTel AvivIsrael
| | - Arik Zaretski
- Department of Plastic SurgeryTel Aviv Sourasky Medical CenterTel AvivIsrael
| | - Yael Cohen
- Division of HematologyTel Aviv Sourasky Medical CenterTel AvivIsrael
| | - Yuval Shapira
- Department of NeurosurgeryTel Aviv Sourasky Medical CenterTel AvivIsrael
| | - Eyal Gur
- Department of Plastic SurgeryTel Aviv Sourasky Medical CenterTel AvivIsrael
| | - Ravit Yanko
- Department of Plastic SurgeryTel Aviv Sourasky Medical CenterTel AvivIsrael
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14
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Milavec H, Ravikumar N, Syn NL, Yentia Soekojo C, Chng WJ, Kumar N. Surgical Management of Multiple Myeloma With Symptomatic Involvement of the Spine. Int J Spine Surg 2020; 14:785-794. [PMID: 33097585 DOI: 10.14444/7112] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Multiple myeloma (MM) is the most frequent primary malignancy of the spine. We aimed to investigate the clinical presentation, surgical indications and outcomes, complications, survival, and its influencing factors in surgically treated MM patients with symptomatic involvement of the spine (SIS). METHODS Retrospective analysis of prospectively collected data. Out of 350 MM patients treated at our institution over a period of 12 years (2006-2018), we identified 24 patients who were surgically treated for SIS. We collected data on demographics, clinical presentation, comorbidities, surgical indications, and outcomes and investigated the factors predisposing to postoperative complications and survival. RESULTS The median follow-up duration was 85 months; median overall survival (OS) was 50 months. Clinical presentation at admission included pain (88%), sensory and/or motor deficit (67%), and bowel/bladder dysfunction (25%). Symptomatic pathological fractures were seen in 33%. Predominant surgical indications were rapid neurological deterioration with or without spinal cord compression (SCC), followed by mechanical instability. The majority of our patients benefited from surgery in terms of pain reduction in the short term as well as in the long term. There were 21% patients with surgical-related complications (<3 months). Surgical site infections occurred in 17%, without any obvious factors predisposing to infective complications. Neurological deterioration during hospital stay, especially in the presence of motor deficit and/or bowel/bladder dysfunction, significantly reduced OS. CONCLUSIONS Sudden-onset neurological deterioration was the predominant factor leading to surgery. We achieved good short- and long-term pain reduction. Surgery is a valuable option for MM patients with SIS who present with rapid neurological deterioration with or without SCC and/or mechanical instability.
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Affiliation(s)
- Helena Milavec
- Department of Orthopaedic Surgery, National University Health System, Singapore.,Department of Orthopaedic Surgery and Traumatology, Spine Unit, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Nivetha Ravikumar
- Department of Orthopaedic Surgery, National University Health System, Singapore
| | - Nicholas L Syn
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Wee Joo Chng
- Department of Haematology-Oncology, National University Health System, Singapore
| | - Naresh Kumar
- Department of Orthopaedic Surgery, National University Health System, Singapore
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Yao X, Xu Z, Du X. PKP/PVP combine chemotherapy in the treatment of multiple myeloma patients with vertebral pathological fractures: minimum 3-year follow-up of 108 cases. J Orthop Surg Res 2019; 14:42. [PMID: 30744644 PMCID: PMC6371465 DOI: 10.1186/s13018-019-1078-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 01/24/2019] [Indexed: 12/14/2022] Open
Abstract
Background Multiple myeloma (MM) is a blood system malignant tumor, which often leads to osteolytic bone destruction, and the vertebral column is the primary site of involvement. However, the efficacy and prognosis of percutaneous kyphoplasty/vertebroplasty (PKP/PVP) for simple vertebral pathological fractures in patients with multiple myeloma are not yet unified. The primary objective of this study was to investigate the efficacy and prognosis of PKP/PVP in the treatment of multiple myeloma patients with vertebral pathological fractures. Methods A total of 108 patients with MM from Beijing Chao-Yang Hospital from 2007 to 2013 were enrolled. Of these, 52 patients underwent PKP/PVP surgery and chemotherapy (surgery group) and 56 received only chemotherapy (chemotherapy group). The age, gender, International Staging System (ISS), fracture location, segment, visual analog scale (VAS), Oswestry Disability Index (ODI), comprehensive treatment satisfaction, stem cell transplantation, overall survival (OS), mortality rate, and the cause of death of patients were recorded; the mean follow-up time was 42.46 months. Results The average age of patients in surgery and chemotherapy groups was 60.8 years and 58.1 years, and the mean survival time was 41.98 months and 43.30 months, respectively. The VAS score at 1 month and last follow-up after treatment in surgery group were significantly lower than those in the chemotherapy group (P < 0.05); the ODI at 1 month after treatment in the surgery group was significantly lower than that in the chemotherapy group (P < 0.05); no significant difference was observed in the 3-year mortality rate between surgery and chemotherapy groups. The number of patients who developed activity disorder in the surgery group was significantly less than that in the chemotherapy group (P < 0.05). The OS of patients in ISS stage III was significantly less than that in ISS stages I and II (P < 0.05). Conclusions PKP/PVP surgery can greatly relieve the pain caused by fractures, reduce the risk of being completely bedridden and pulmonary infection, and improve the quality of life of patients; however, it did not affect mortality rate and overall survival time in patients. Trial registration As this was a retrospective study, it did not require ethical approval; all patients had signed informed consent when they received treatment, and all treatment options were voluntary.
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Affiliation(s)
- Xingchen Yao
- Department of Orthopaedics, Beijing Chao-Yang Hospital, Capital Medical University, No.8 Gongren Tiyuguan Nanlu, Chaoyang district, Beijing, China
| | - Ziyu Xu
- Department of Orthopaedics, Beijing Chao-Yang Hospital, Capital Medical University, No.8 Gongren Tiyuguan Nanlu, Chaoyang district, Beijing, China
| | - Xinru Du
- Department of Orthopaedics, Beijing Chao-Yang Hospital, Capital Medical University, No.8 Gongren Tiyuguan Nanlu, Chaoyang district, Beijing, China.
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Abstract
Skeletal lesions caused by multiple myeloma often lead to pain, pathological fractures, spinal instability, and compression of the spinal cord and nerve roots. The choice of therapy options is made by an interdisciplinary basis with oncologists and radiotherapists on the basis of comorbidities, prognosis, localization, and number of lesions. Surgical management has a supportive role in pain relief, the prevention and treatment of pathological fractures, and the decompression of the spinal cord and nerve roots. An adequate preoperative workup is essential for planning surgical treatment, which includes magnetic resonance imaging of the spine. In the case of unstable spinal lesions, minimally invasive and open surgical procedures, as well as their combination, are available for stabilization and decompression. In impending and pathological fractures of the extremities, surgical procedures are superior to conservative therapy for pain relief, restoring stability, walking ability, and limb function. There are multiple options available, including osteosynthesis using bone cement and plates, intramedullary nails, and bone replacement with implants and tumor endoprostheses with good functional results. Permanent reconstruction of the lesions should be the goal of any surgical intervention. The indication for curative, wide resection of the tumor should be considered for solitary plasmocytomas of the bone. Adjuvant radiotherapy leads to significantly improved local tumor control and should be considered after resection and stabilization.
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