Early-stage myeloma, single bone lesions, a negative bone marrow biopsy, and normal M-protein levels in the serum are associated with improved survival in multiple myeloma patients following surgery for skeletal complications, according to a recent German study.

Multiple myeloma is commonly associated with a number of skeletal complications, including fractures, spinal cord compression, elevated calcium levels in the blood, and severe bone pain.

These complications arise as a result of skeletal weakening due to bone lesions. Bone lesions are the result of an under activity or absence of cells responsible for bone formation paired with the over activity of cells that degrade bone (See related Beacon ^[1] news). Up to 90 percent of multiple myeloma patients may develop bone lesions over the course of their disease.

Myeloma-associated bone lesions typically do not heal, even in patients who have been in remission for years. Skeletal complications may, therefore, create permanent disabilities, require surgical intervention, and even affect survival.

According to a recent review, fractures caused by bone lesions have been associated with a 44 percent increased risk of death in myeloma patients (for more information, see Seminars in Oncology ^[2]).

Since the introduction of bisphosphonate treatment for bone disease, the number of myeloma patients requiring surgical intervention for skeletal complications has dropped below 10 percent, according to Dr. James Berenson of the Institute for Myeloma & Bone Cancer Research.

“Most commonly performed procedures are minimally invasive procedures for vertebral compression fractures including kyphoplasty or vertebroplasty, procedures for femoral [hip] or humeral [upper arm] fractures including rod placement,” explained Dr. Berenson.

For myeloma-related skeletal complications, surgical therapy is a form of palliative care.  It reduces the severity of disease symptoms and may improve quality of life, but does not necessarily stop disease progression or provide a cure.

“Patients who undergo these procedures have a marked improvement in their pain and mobility,” stated Dr. Berenson.

In this study, researchers determined which factors were associated with improved survival following palliative surgical treatments for skeletal complications.

The study included a total of 75 multiple myeloma patients who required surgical intervention for myeloma-related skeletal complications. Those who received surgery had, or were at risk for, bone lesion-associated fractures or were suffering from neurological impairment due to spine lesions.

For most of the study participants, lesions were located in the spine, thigh, and upper arm.

Before the procedure, all patients reported pain, 65 percent reported fractures, and 31 percent reported neurological impairment. Patients had experienced these symptoms for an average of 7.5 months.

A number of surgical procedures were performed, including removal of the lesion, implantation of prosthetic devices, vertebroplasty, kyphoplasty, and cement stabilization of the bone.

Follow up was performed between one and 25 years after surgery.

A total of 87 percent of patients survived more than one year after surgery. Five years post-surgery, 37 percent of patients were alive. The median survival was 4.7 years.

Patients who experienced symptoms of myeloma bone lesions for more than six months had shorter survival periods following surgery (2.2 years) than those who experienced symptoms for less than 6 months (4.9 years).

Patients with a single bone lesion survived 9.5 years compared to 3.7 years for patients with multiple lesions.

Similarly, patients with negative bone marrow biopsies survived longer (10 years) than those with positive biopsies (3.8 years).

Although patients diagnosed with advanced myeloma (Durie-Salmon ^[3] stages II and III) had nearly identical survival times (3.66 and 3.33 years, respectively), patients diagnosed with early-stage myeloma (Durie-Salmon Stage I) survived significantly longer, an average of 9.5 years.

Patients with normal M-protein levels survived significantly longer (8.8 years) than patients with elevated M-protein levels (3.3 years). In multiple myeloma, the M-protein is overproduced by plasma cells and cannot effectively fight infections.

Location of bone lesions did not have a statistically significant impact on survival times following surgery.

For more information, please see the study in International Orthopaedics ^[4] (abstract).