Extensive Remineralization of Large Pelvic Lytic Lesions Following Total Therapy Treatment in Patients With Multiple Myeloma.
Extensive Remineralization of Large Pelvic Lytic Lesions Following Total Therapy Treatment in Patients With Multiple Myeloma.
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DOI：
10.1002/jbmr.3111
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发表时间：
2017-06
期刊：
影响因子：
--
通讯作者：
Zangari M
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作者：
Mohan M;Samant RS;Yoon D;Buros AF;Branca A;Montgomery CO;Nicholas R;Suva LJ;Morello R;Thanendrarajan S;Schinke C;Yaccoby S;van Rhee F;Davies FE;Morgan GJ;Zangari M
溶骨性骨病变是多发性骨髓瘤骨疾病的标志。骨破坏与严重不平衡的骨重建相关，继发于破骨细胞生成增加和成骨细胞显著抑制。骨盆的溶解性病变在MM患者中相对常见，并且已知由于骨折的高风险而导致发病率增加，通常需要广泛的手术干预。在观察到在接受全疗法方案治疗的患者中进行的系列大骨盆CT评估的非预期放射学改善后，回顾性分析了在接受骨髓瘤全疗法4治疗的患者中通过CT/PET扫描进行的骨盆溶骨性病变的放射学变化。在基线PET/CT扫描时确定了62例直径> 1 cm的溶骨性盆腔病变患者。随访CT研究表明，27/62例（43%）基线盆腔病变较大的患者在溶解性皮质部位实现了放射性致密矿化的显著再积聚。发生再矿化的溶骨性病变平均大小为4 cm（范围：1.3 cm - 10 cm）。这项研究清楚地表明，在接受Total Therapy 4治疗的MM患者中，很大一部分患者发生了大盆腔病变中的矿物质沉积，这可能影响患者的结局、生活质量和未来的治疗策略。
Osteolytic bone lesions are a hallmark of multiple myeloma bone disease. Bone destruction is associated with severely imbalanced bone remodeling, secondary to increased osteoclastogenesis and significant osteoblast suppression. Lytic lesions of the pelvis are relatively common in MM patients and are known to contribute to the increased morbidity due to the high risk of fracture that frequently demands extensive surgical intervention. After observing unexpected radiological improvement in serial large pelvic CT assessment in a patient treated in a total therapy protocol, the radiographic changes of pelvic osteolytic lesions by CT/PET scanning in patients who received total therapy 4 treatment for myeloma were retrospectively analyzed. Sixty-two (62) patients with lytic pelvic lesions > 1 cm in diameter were identified at baseline PET/CT scanning. Follow-up CT studies demonstrated that 27/62 patients (43%) with large baseline pelvic lesions achieved significant reaccumulation of radiodense mineralization at the lytic cortical site. The average size of lytic lesions in which remineralization occurred was 4 cm (range: 1.3 cm – 10 cm). This study clearly demonstrates that mineral deposition in large pelvic lesions occurs in a significant proportion of MM patients treated with Total Therapy 4, potentially affecting patient outcomes, quality-of-life and future treatment strategies.