Avascular necrosis of femoral and/or humeral heads in multiple myeloma: Results of a prospective study of patients treated with dexamethasone-based regimens and high-dose chemotherapy

Giampaolo Talamo, Edgardo Angtuaco, Ronald C. Walker, Li Dong, Marisa H. Miceli, Maurizio Zangari, Guido Tricot, Bart Barlogie, Elias Anaissie

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49 Scopus citations

Abstract

Purpose: To assess the prevalence, time of onset, risk factors, and outcome of avascular necrosis (AVN) of bone in patients with multiple myeloma undergoing antineoplastic therapy. Patients and Methods: A total of 553 consecutive assessable patients were enrolled onto a treatment protocol consisting of dexamethasone-containing induction chemotherapy, autologous stem-cell transplantation, consolidation chemotherapy, and maintenance with interferon alfa. Patients were randomly assigned to receive thalidomide (269 patients) or no thalidomide (284 patients) throughout the study period. Results: With a median follow-up of 33 months (range, 5 to 114 months), AVN of the femoral head(s) developed in 49 patients (9%). Median time to onset of AVN was 12 months (range, 2 to 41 months). Three risk factors for AVN were identified by multivariate analysis: cumulative dexamethasone dose (odds ratio [OR], 1.028; 95% CI, 1.012 to 1.044; P = .0006 [per 40 mg dexamethasone]), male sex (OR, 0.390; 95% CI, 0.192 to 0.790; P = .009), and younger age (OR, 0.961; 95% CI, 0.934 to 0.991 per year; P = .0122). Thalidomide-treated patients had a prevalence of AVN similar to that of the control group (8% v 10%, respectively; P = .58). AVN-related pain and limited range of motion of the affected joint were present in only nine and four patients, respectively, and four patients underwent hip replacement because of AVN. Fluorine-18 fluorodeoxyglucose positron emission tomography failed to detect abnormal uptake in the AVN-affected bones. Conclusion: AVN is a rare and usually asymptomatic complication during myeloma therapy. Cumulative dexamethasone dose, male sex, and younger age, but not thalidomide, increase the risk of AVN.

Original languageEnglish (US)
Pages (from-to)5217-5223
Number of pages7
JournalJournal of Clinical Oncology
Volume23
Issue number22
DOIs
StatePublished - Dec 1 2005

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

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