Natural History Of Skeletal-Related Events Among 620 Patients With Multiple Myeloma Who Received First- And Second-Line Therapy With Novel Agents: A Single-Center Analysis

Context: Skeletal-related events (SREs) that include pathological fractures, spinal cord compression (SCC) and need for radiotherapy or surgery to the bone are frequent complications of multiple myeloma (MM). Objective: To evaluate the SRE rate in MM patients who received frontline and second-line therapy with proteasome inhibitors (PIs) or immunomodulatory drug (IMiD)-based therapies. Design: Prospectively maintained database. Setting: A referral center in Athens, Greece. Patients: MM patients who received frontline therapy in the Department of Clinical Therapeutics, University of Athens, Greece, between 20072017. Interventions: Patients had a whole-body skeletal survey using either conventional radiography (WBXR) or low-dose CT (WBLDCT) at diagnosis and whenever clinically indicated. Main outcome measures: SRE incidence. Results: 620 consecutive patients with symptomatic MM (316M/304F, median age: 65 years) were studied. The median follow-up was 54 months. SREs were observed in 271 (44%) patients at diagnosis: 213 (34%) presented with pathological fractures, while 34 (5.5%) needed bone surgery, 45 (7.2%) radiotherapy, and 31 (5%) patients presented with SCC. SRE incidence was higher in patients with osteolytic lesions (76.4% vs. 12.4%, P Conclusions: SREs remain a significant complication in MM.