Effect of systemic therapies on outcomes following vertebroplasty among patients with multiple myeloma

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Abstract

BACKGROUND AND PURPOSE: The role of vertebroplasty in patients with myeloma remains relatively undefined. Accordingly, we sought to better define the efficacy of vertebroplasty for myeloma-Associated fractures and determine the effect of procedure timing relative to the initiation of systemic therapy on outcomes and complication rates. MATERIALS AND METHODS: Clinical, laboratory, and medication data were retrieved for 172 patients with multiple myeloma treated with vertebroplasty since October 2000. Quantitative outcome data (Roland-Morris Disability Questionnaire [scale, 0-24] and the Numeric Rating Scale [0 -10] for pain at rest and with activity) were collected immediately pre-And postoperatively and at 1 week, 1 month, 6 months, and 1 year following vertebroplasty. Patients with 50% improvement on the Numeric Rating Scale and 40% improvement on the Roland-Morris Disability Questionnaire were classified as "responders." Peri-And postoperative complications were also collected. RESULTS: Significant median improvement in the Roland-Morris Disability and rest and activity Numeric Rating Scale scores (15, 2, and 6 points, respectively; P ≤ .0001) persisted at 1 year without significant change from the immediate postoperative scores (P ≤ .36). Patients on systemic therapy at the time of vertebroplasty were more likely to achieve "responder status," compared with patients not on systemic therapy, for the Numeric Rating Scale pain at rest score (P≤ .01) and the Roland-Morris Disability Questionnaire score (P ≤ .003), with no difference in complication rates (χ2 = 0.17, P ≤ .68). CONCLUSIONS: Vertebroplasty is an effective therapy for patients with myeloma with symptomatic compression fractures. Favorable outcomes are more likely to be achieved when spinal augmentation is performed after systemic therapy is initiated. Complication rates were not affected by the timing of systemic therapy.

Original languageEnglish (US)
Pages (from-to)2400-2406
Number of pages7
JournalAmerican Journal of Neuroradiology
Volume37
Issue number12
DOIs
StatePublished - Dec 1 2016

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Vertebroplasty
Multiple Myeloma
Therapeutics
Compression Fractures
Pain
Surveys and Questionnaires

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology

Cite this

@article{af2af67170124e919801629b56040274,
title = "Effect of systemic therapies on outcomes following vertebroplasty among patients with multiple myeloma",
abstract = "BACKGROUND AND PURPOSE: The role of vertebroplasty in patients with myeloma remains relatively undefined. Accordingly, we sought to better define the efficacy of vertebroplasty for myeloma-Associated fractures and determine the effect of procedure timing relative to the initiation of systemic therapy on outcomes and complication rates. MATERIALS AND METHODS: Clinical, laboratory, and medication data were retrieved for 172 patients with multiple myeloma treated with vertebroplasty since October 2000. Quantitative outcome data (Roland-Morris Disability Questionnaire [scale, 0-24] and the Numeric Rating Scale [0 -10] for pain at rest and with activity) were collected immediately pre-And postoperatively and at 1 week, 1 month, 6 months, and 1 year following vertebroplasty. Patients with 50{\%} improvement on the Numeric Rating Scale and 40{\%} improvement on the Roland-Morris Disability Questionnaire were classified as {"}responders.{"} Peri-And postoperative complications were also collected. RESULTS: Significant median improvement in the Roland-Morris Disability and rest and activity Numeric Rating Scale scores (15, 2, and 6 points, respectively; P ≤ .0001) persisted at 1 year without significant change from the immediate postoperative scores (P ≤ .36). Patients on systemic therapy at the time of vertebroplasty were more likely to achieve {"}responder status,{"} compared with patients not on systemic therapy, for the Numeric Rating Scale pain at rest score (P≤ .01) and the Roland-Morris Disability Questionnaire score (P ≤ .003), with no difference in complication rates (χ2 = 0.17, P ≤ .68). CONCLUSIONS: Vertebroplasty is an effective therapy for patients with myeloma with symptomatic compression fractures. Favorable outcomes are more likely to be achieved when spinal augmentation is performed after systemic therapy is initiated. Complication rates were not affected by the timing of systemic therapy.",
author = "Robert McDonald and McDonald, {Jennifer S} and Kallmes, {David F} and Lehman, {Vance T} and Diehn, {F. E.} and Wald, {J. T.} and Thielen, {K. R.} and Angela Dispenzieri and Luetmer, {Patrick H}",
year = "2016",
month = "12",
day = "1",
doi = "10.3174/ajnr.A4925",
language = "English (US)",
volume = "37",
pages = "2400--2406",
journal = "American Journal of Neuroradiology",
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TY - JOUR

T1 - Effect of systemic therapies on outcomes following vertebroplasty among patients with multiple myeloma

AU - McDonald, Robert

AU - McDonald, Jennifer S

AU - Kallmes, David F

AU - Lehman, Vance T

AU - Diehn, F. E.

AU - Wald, J. T.

AU - Thielen, K. R.

AU - Dispenzieri, Angela

AU - Luetmer, Patrick H

PY - 2016/12/1

Y1 - 2016/12/1

N2 - BACKGROUND AND PURPOSE: The role of vertebroplasty in patients with myeloma remains relatively undefined. Accordingly, we sought to better define the efficacy of vertebroplasty for myeloma-Associated fractures and determine the effect of procedure timing relative to the initiation of systemic therapy on outcomes and complication rates. MATERIALS AND METHODS: Clinical, laboratory, and medication data were retrieved for 172 patients with multiple myeloma treated with vertebroplasty since October 2000. Quantitative outcome data (Roland-Morris Disability Questionnaire [scale, 0-24] and the Numeric Rating Scale [0 -10] for pain at rest and with activity) were collected immediately pre-And postoperatively and at 1 week, 1 month, 6 months, and 1 year following vertebroplasty. Patients with 50% improvement on the Numeric Rating Scale and 40% improvement on the Roland-Morris Disability Questionnaire were classified as "responders." Peri-And postoperative complications were also collected. RESULTS: Significant median improvement in the Roland-Morris Disability and rest and activity Numeric Rating Scale scores (15, 2, and 6 points, respectively; P ≤ .0001) persisted at 1 year without significant change from the immediate postoperative scores (P ≤ .36). Patients on systemic therapy at the time of vertebroplasty were more likely to achieve "responder status," compared with patients not on systemic therapy, for the Numeric Rating Scale pain at rest score (P≤ .01) and the Roland-Morris Disability Questionnaire score (P ≤ .003), with no difference in complication rates (χ2 = 0.17, P ≤ .68). CONCLUSIONS: Vertebroplasty is an effective therapy for patients with myeloma with symptomatic compression fractures. Favorable outcomes are more likely to be achieved when spinal augmentation is performed after systemic therapy is initiated. Complication rates were not affected by the timing of systemic therapy.

AB - BACKGROUND AND PURPOSE: The role of vertebroplasty in patients with myeloma remains relatively undefined. Accordingly, we sought to better define the efficacy of vertebroplasty for myeloma-Associated fractures and determine the effect of procedure timing relative to the initiation of systemic therapy on outcomes and complication rates. MATERIALS AND METHODS: Clinical, laboratory, and medication data were retrieved for 172 patients with multiple myeloma treated with vertebroplasty since October 2000. Quantitative outcome data (Roland-Morris Disability Questionnaire [scale, 0-24] and the Numeric Rating Scale [0 -10] for pain at rest and with activity) were collected immediately pre-And postoperatively and at 1 week, 1 month, 6 months, and 1 year following vertebroplasty. Patients with 50% improvement on the Numeric Rating Scale and 40% improvement on the Roland-Morris Disability Questionnaire were classified as "responders." Peri-And postoperative complications were also collected. RESULTS: Significant median improvement in the Roland-Morris Disability and rest and activity Numeric Rating Scale scores (15, 2, and 6 points, respectively; P ≤ .0001) persisted at 1 year without significant change from the immediate postoperative scores (P ≤ .36). Patients on systemic therapy at the time of vertebroplasty were more likely to achieve "responder status," compared with patients not on systemic therapy, for the Numeric Rating Scale pain at rest score (P≤ .01) and the Roland-Morris Disability Questionnaire score (P ≤ .003), with no difference in complication rates (χ2 = 0.17, P ≤ .68). CONCLUSIONS: Vertebroplasty is an effective therapy for patients with myeloma with symptomatic compression fractures. Favorable outcomes are more likely to be achieved when spinal augmentation is performed after systemic therapy is initiated. Complication rates were not affected by the timing of systemic therapy.

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U2 - 10.3174/ajnr.A4925

DO - 10.3174/ajnr.A4925

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