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8 - Myeloma bone disease – pathogenesis of bone destruction and therapeutic strategies

from Section 2 - Biological basis for targeted therapies in myeloma

Published online by Cambridge University Press:  18 December 2013

By
Andrew Chantry  and
Neil Rabin
Edited by
Stephen A. Schey ,
Kwee L. Yong ,
Robert Marcus  and
Kenneth C. Anderson
Stephen A. Schey
Affiliation:
Department of Haematology, King’s College Hospital, London
Kwee L. Yong
Affiliation:
Department of Haematology, University College Hospital, London
Robert Marcus
Affiliation:
Department of Haematology, King’s College Hospital, London
Kenneth C. Anderson
Affiliation:
Dana-Farber Cancer Institute, Boston
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Summary

Introduction

Myeloma bone disease is a major cause of morbidity in patients, the clinical manifestations of which include pain, cord compression, loss of mobility and deformity. The clinical features of myeloma bone disease are due to osteoporosis, or focal lytic lesions leading to pathological fractures, vertebral collapse and hypercalcemia (Figure 8.1). Neurological sequelae secondary to bone disease are commonly caused by compression of nerves by damaged and displaced bone and most dramatically include spinal cord compression, which often presents as a neurosurgical emergency occurring in up to 5% of patients with myeloma (Figure 8.2)[1]. Indeed, consequences of osteolytic bone disease are often the presenting features of myeloma. Approximately 67% of patients with myeloma present with bone pain and up to 90% of patients with myeloma exhibit features of myeloma bone disease at some stage of the disease course[2,3].

The bone marrow micro-environment has long been recognized as a hospitable locale for the growth and rapid expansion of myeloma and other hematological malignancies as well as the metastatic spread of solid tumors including breast and prostate cancers. However, myeloma is uniquely associated with an aggressive and destructive osteolytic bone disease, which not only causes substantial morbidity as a direct result of bone destruction but, owing to the destruction of boney barriers, enables rapid tumor expansion and spread to extra-medullary sites. Once myeloma has escaped from the bone marrow micro-environment, disease enters a leukemic phase and is rapidly fatal.

Type
Chapter
Information
Myeloma
Pathology, Diagnosis, and Treatment
 , pp. 96 - 109
Publisher: Cambridge University Press
Print publication year: 2013

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