Download PDF
Open Access
CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2023; 58(03): 368-377
DOI: 10.1055/s-0043-1770150
Artigo de Atualização
Oncologia

Mieloma Múltiplo (Parte 2) - Atualização sobre a Abordagem da Doença Óssea

Article in several languages: português | English

Authors

  • Alex Guedes 

    1   Grupo de Oncologia Ortopédica, Hospital Santa Izabel, Santa Casa de Misericórdia da Bahia, Salvador, BA, Brasil

  • Ricardo Gehrke Becker 

    2   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 

    3   Departamento do Aparelho Locomotor, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil

Suporte Financeiro Não houve financiamento.
Further Information
Also available at
  Permissions and Reprints
Preview

Resumo

O aumento da expectativa de vida da população mundial levou a incremento concomitante na prevalência de mieloma múltiplo (MM), patologia que geralmente afeta a população idosa. Lesões ósseas são frequentes nos portadores desta condição, demandando abordagem precoce, desde o tratamento medicamentoso, passando pela radioterapia até a cirurgia ortopédica (profilática ou terapêutica) com os objetivos de prevenir ou retardar a ocorrência de fratura, ou, quando este evento já ocorreu, tratá-la mediante estabilização ou substituição (lesões situadas no esqueleto apendicular) e/ou promover estabilização e descompressão medular (lesões situadas no esqueleto axial), proporcionando rápido alívio da dor, retorno à deambulação e ressocialização, devolvendo a qualidade de vida aos pacientes. O objetivo desta revisão é atualizar o leitor sobre a fisiopatologia, a clínica, exames laboratoriais e de imagem, diagnóstico diferencial e abordagem terapêutica da doença óssea no mieloma múltiplo (DOMM).

Palavras-chave

Difosfonatos - Fraturas espontâneas - Mieloma múltiplo - Procedimentos cirúrgicos profiláticos - Procedimentos ortopédicos - Radioterapia.


Publication History

Received: 09 August 2022

Accepted: 16 December 2022

Article published online:
29 June 2023

© 2023. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • Referências

  • 1 Hungria VTM. Doença óssea em mieloma múltiplo. Rev Bras Hematol Hemoter 2007; 29 (01) 60-66
    Search in Google Scholar
  • 2 Kehrer M, Koob S, Kehrer A, Wirtz DC, Schmolders J. Multiple myeloma - Current standards in surgical treatment. Z Orthop Unfall 2019; 157 (02) 164-172
    Search in Google Scholar
  • 3 Galán-Olleros M, Marco J, Oteo D. et al. Orthopedic surgical treatment and perioperative complications in multiple myeloma bone disease: Analysis of a series (2009-2018). Ann Surg Oncol 2021; 28 (02) 1158-1166
    Search in Google Scholar
  • 4 Kyle RA, Gertz MA, Witzig TE. et al. Review of 1027 patients with newly diagnosed multiple myeloma. Mayo Clin Proc 2003; 78 (01) 21-33
    Search in Google Scholar
  • 5 Ponte FM, Garcia Filho RJ, Hadler MB, Korukian M, Ishihara HY. Avaliação do tratamento ortopédico no mieloma múltiplo. Rev Bras Ortop 2002; 37 (05) 162-170
    Search in Google Scholar
  • 6 Katsekis KS, Kelham AS. Orthopaedic management of multiple myeloma lesions. JBJS J Orthop Physician Assist 2018; 6 (04) e40
    Search in Google Scholar
  • 7 Utzschneider S, Schmidt H, Weber P, Schmidt GP, Jansson V, Dürr HR. Surgical therapy of skeletal complications in multiple myeloma. Int Orthop 2011; 35 (08) 1209-1213
    Search in Google Scholar
  • 8 Terpos E, Zamagni E, Lentzsch S. et al; Bone Working Group of the International Myeloma Working Group. Treatment of multiple myeloma-related bone disease: recommendations from the Bone Working Group of the International Myeloma Working Group. Lancet Oncol 2021; 22 (03) e119-e130
    Search in Google Scholar
  • 9 Lentzsch S, Ehrlich LA, Roodman GD. Pathophysiology of multiple myeloma bone disease. Hematol Oncol Clin North Am 2007; 21 (06) 1035-1049 , viii
    Search in Google Scholar
  • 10 Rajkumar SV. Multiple myeloma: 2020 update on diagnosis, risk-stratification and management. Am J Hematol 2020; 95 (05) 548-567
    Search in Google Scholar
  • 11 American Academy of Orthopaedic Surgeons [Internet]. Orthoinfo; c2020. Diseases & Conditions: Multiple Myeloma/Plasmacytoma [cited 2022 Mar 12]. Available from: https://orthoinfo.aaos.org/en/diseases--conditions/multiple-myelomaplasmacytoma/
  • 12 Surgeon's Committee of the Chinese Myeloma Working Group of the International Myeloma Foundation. Consensus on Surgical Management of Myeloma Bone Disease. Orthop Surg 2016; 8 (03) 263-269
    Search in Google Scholar
  • 13 Guedes A, Oliveira MBDR, Costa FM, de Melo AS. Updating on Bone and Soft Tissue Sarcomas Staging. Rev Bras Ortop 2021; 56 (04) 411-418
    Search in Google Scholar
  • 14 Guedes A, Oliveira MBDR, de Melo AS, Carmo CCMD. Update in Imaging Evaluation of Bone and Soft Tissue Sarcomas. Rev Bras Ortop 2023; 58 (02) 179-190
    Search in Google Scholar
  • 15 Guedes A, Moreira FD, Mattos ESR, Freire MDM, Guedes AAL, Freire ANM. Abordagem ortopédica das metástases ósseas de carcinoma e mieloma múltiplo. Rev SBC 2022; 23 (62) 83-90
    Search in Google Scholar
  • 16 Guedes A. Mieloma múltiplo. In: Oliveira LG. ed. Tratado de doenças osteometabólicas. Goiânia: Kelps; 2020: 795-818
    Search in Google Scholar
  • 17 Rudzianskiene M, Inciura A, Gerbutavicius R. et al. Single vs. multiple fraction regimens for palliative radiotherapy treatment of multiple myeloma : A prospective randomised study. Strahlenther Onkol 2017; 193 (09) 742-749
    Search in Google Scholar
  • 18 Kyriakou C, Molloy S, Vrionis F. et al. The role of cement augmentation with percutaneous vertebroplasty and balloon kyphoplasty for the treatment of vertebral compression fractures in multiple myeloma: a consensus statement from the International Myeloma Working Group (IMWG). Blood Cancer J 2019; 9 (03) 27
    Search in Google Scholar
  • 19 Hirsch AE, Jha RM, Yoo AJ. et al. The use of vertebral augmentation and external beam radiation therapy in the multimodal management of malignant vertebral compression fractures. Pain Physician 2011; 14 (05) 447-458
    Search in Google Scholar
  • 20 Palumbo A, Avet-Loiseau H, Oliva S. et al. Revised international staging system for multiple myeloma: A report from International Myeloma Working Group. J Clin Oncol 2015; 33 (26) 2863-2869
    Search in Google Scholar
  • 21 Piccioli A, Piana R, Lisanti M. et al; Italian Orthopaedic Society (SIOT) Bone Metastasis Study Group. Carbon-fiber reinforced intramedullary nailing in musculoskeletal tumor surgery: a national multicentric experience of the Italian Orthopaedic Society (SIOT) Bone Metastasis Study Group. Injury 2017; 48 (Suppl. 03) S55-S59
    Search in Google Scholar
  • 22 Soriani A, Strigari L, Petrongari MG. et al. The advantages of carbon fiber based orthopedic devices in patients who have to undergo radiotherapy. Acta Biomed 2020; 91 (03) e2020057
    Search in Google Scholar
  • 23 Sakellariou VI, Mavrogenis AF, Savvidou O, Sim FH, Papagelopoulos PJ. Reconstruction of multiple myeloma lesions around the pelvis and acetabulum. Eur J Orthop Surg Traumatol 2015; 25 (04) 643-653
    Search in Google Scholar
  • 24 Gazendam A, Axelrod D, Wilson D, Ghert M. Emerging Concepts in the Surgical Management of Peri-Acetabular Metastatic Bone Disease. Curr Oncol 2021; 28 (04) 2731-2740
    Search in Google Scholar
  • 25 Ogawa R, Hirao M, Umezu T, Yanagimoto S. Total Hip Arthroplasty with a Cementless Acetabular Component and Impaction Bone Grafting for Dysplastic Osteoarthritis Complicated by Multiple Myeloma. Case Rep Orthop 2022; 2022: 3939356
    Search in Google Scholar
  • 26 Wangsaturaka P, Asavamongkolkul A, Waikakul S, Phimolsarnti R. The results of surgical management of bone metastasis involving the periacetabular area: Siriraj experience. J Med Assoc Thai 2007; 90 (05) 1006-1013
    Search in Google Scholar
  • 27 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 (05) 785-794
    Search in Google Scholar
  • 28 Laufer I, Rubin DG, Lis E. et al. The NOMS framework: approach to the treatment of spinal metastatic tumors. Oncologist 2013; 18 (06) 744-751
    Search in Google Scholar
  • 29 Mirels H. Metastatic disease in long bones. A proposed scoring system for diagnosing impending pathologic fractures. Clin Orthop Relat Res 1989; (249) 256-264
    Search in Google Scholar
  • 30 Jawad MU, Scully SP. In brief: classifications in brief: Mirels' classification: metastatic disease in long bones and impending pathologic fracture. Clin Orthop Relat Res 2010; 468 (10) 2825-2827
    Search in Google Scholar
  • 31 Gerrand CH, Rankin K. Metastatic Disease in Long Bones. A Proposed scoring system for diagnosing impending pathologic fractures. In: Banaszkiewicz P, Kader DF. eds. Classic papers in orthopaedics. London: Springer; 2014: 479-480
    Search in Google Scholar
  • 32 Topkar OM, Erol B. Clinical outcomes and complications of surgical interventions for multiple myeloma lesions in the extremities and pelvis: A retrospective clinical study. Acta Orthop Traumatol Turc 2021; 55 (02) 159-165
    Search in Google Scholar