PB2187 SURGICAL TREATMENT OF BONE DISEASE IN MULTIPLE MYELOMA PATIENTS
Authors: Szczepanek D. , Wasik‐Szczepanek E. , Sokolowska B. , Szczepanek A. , Spiewak‐Ston H. , Wach M. , Adamczyk‐Cioch M. 
Published: June 2019

Background:

The definition of bone disease in multiple myeloma bone disease (MMBD) includes a wide range of clinical symptoms as well as anatomical changes. These include bone pain, osteoporosis, osteolytic lesions, pathological fractures, spinal cord and nerve root compression and extramedullary myeloma tumors. One of the most common symptoms reported by multiple myeloma (MM) patients with bone disease is pain. It is particularly severe in the case of localization of lesions in the spine and caused by compression fracture of the vertebral body. In the case of patients with MM, MMBD is most often related to the spine and about 11‐24% of patients have spinal cord compression. This is one of the most dangerous complications of MMBD. In each case, it requires special attention, and sometimes rapid surgical intervention.

Aims:

Determination of the neurosurgical treatment possibilities of patients with multiple myeloma, depending on reported complaints and neurological symptoms resulting from damage to the nervous system.

Methods

Retrospective analysis of MM patients hospitalized in the Department of Neurosurgery and Pediatric Neurosurgery of the Medical University of Lublin in 2005‐2017 included 27 people: 12 (44%) women and 15 (56%) men aged 47‐82 (average 62 years). In each case, the clinical condition was assessed according to the Karnofsky performance status scale, the neurological status and medical imaging (computed tomography, magnetic resonance) were performed. In the majority of patients (25/93%) the diagnosis of MM was made on the basis of histopathological examination of the material collected during the surgery. In three cases, a plasmocytoma solitare was found.

Results:

Bone pain and neurological symptoms resulting from damage of the central nervous system were the main reason for hospitalization and the main indication for surgical procedures in patients with MM. The most frequently performed procedure was laminectomy (15/56%), and more rarely (7/26%), spinal stabilization was performed in the event of instability risk. Myeloma changes occurred mainly in the spine. In 4 cases, the intracranial location was observed (two times the cranial bone tumor buckling to its interior causing pressure to right and left parietal lobe, sphenoid sinus tumor and temporal bone petrous pyramid tumor). One patient was diagnosed with an orbital wall tumor. Among the entire study group there was only one postoperative complication observed (facial nerve paresis), which concerned the patient after the removal of a large temporal bone pyramid tumor. In 20 (74%) patients, improvement was stated, stabilization of neurological status in comparison with the period before surgery was found in 7 patients (26%). There was no deterioration of condition in any patient. In two cases, due to earlier diagnosis of MM, chemotherapy preceded hospitalization at the Neurosurgery Department. In 25 (93%) patients further postoperative treatment was used: chemotherapy (24/89%), radiotherapy (9/33%) or autologous hematopoietic stem cell transplantation (8/30%).

Summary/Conclusion:

Surgical treatment is one of the elements of a holistic therapeutic plan in which chemotherapy plays the most important role. Its goal is not radical treatment of MM, but a significant reduction of pain and often serious neurological complications. Although at the present time there is no irrefutable evidence that surgery affects the extension of overall survival, undoubtedly it often significantly improves its quality.