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

Research output: Contribution to journalArticle

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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

Fingerprint

Femur Head Necrosis
Humeral Head
Multiple Myeloma
Dexamethasone
Prospective Studies
Drug Therapy
Necrosis
Thalidomide
Osteonecrosis
Odds Ratio
Consolidation Chemotherapy
Induction Chemotherapy
Sex Ratio
Fluorodeoxyglucose F18
Stem Cell Transplantation
Clinical Protocols
Articular Range of Motion
Interferon-alpha
Positron-Emission Tomography
Antineoplastic Agents

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

Cite this

Talamo, Giampaolo ; Angtuaco, Edgardo ; Walker, Ronald C. ; Dong, Li ; Miceli, Marisa H. ; Zangari, Maurizio ; Tricot, Guido ; Barlogie, Bart ; Anaissie, Elias. / 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. In: Journal of Clinical Oncology. 2005 ; Vol. 23, No. 22. pp. 5217-5223.
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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.",
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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. / Talamo, Giampaolo; Angtuaco, Edgardo; Walker, Ronald C.; Dong, Li; Miceli, Marisa H.; Zangari, Maurizio; Tricot, Guido; Barlogie, Bart; Anaissie, Elias.

In: Journal of Clinical Oncology, Vol. 23, No. 22, 01.12.2005, p. 5217-5223.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Avascular necrosis of femoral and/or humeral heads in multiple myeloma

T2 - Results of a prospective study of patients treated with dexamethasone-based regimens and high-dose chemotherapy

AU - Talamo, Giampaolo

AU - Angtuaco, Edgardo

AU - Walker, Ronald C.

AU - Dong, Li

AU - Miceli, Marisa H.

AU - Zangari, Maurizio

AU - Tricot, Guido

AU - Barlogie, Bart

AU - Anaissie, Elias

PY - 2005/12/1

Y1 - 2005/12/1

N2 - 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.

AB - 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.

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