ABSTRACT
Multiple myeloma (MM) ranges second of all hematological malignancies and occurs most commonly in elderly patients. Almost all MM patients develop bone lesions in the course of their disease or have evidence of bone loss at initial diagnosis. Whole-body conventional radiography remains the gold standard in the diagnostic evaluation, albeit computed tomography (CT) and magnetic resonance imaging (MRI) are increasingly used as complementary techniques in the more sensitive detection of osteolytic processes. Bisphosphonates like zoledronate or pamidronate represent the cornerstone therapeutics in osteolytic disease, and are effective supportives to potent anti-myeloma therapies, including novel agents such as the proteasome inhibitor bortezomib or immunomodulatory drugs (IMIDs, e. g. thalidomide or lenalidomide). Several studies are ongoing to investigate the effects of alternative bone-seeking agents and their therapeutic potential for the management of myeloma bone disease, such as denosumab (RANKL-neutralizing antibody), anti-sclerostin (monoclonal antibody, generated against sclerostin) or sotatercept (potent activin-A inhibitor). This review summarizes the most prominent data on myeloma bone disease pathogenesis, the role of imaging techniques as well as therapy and prevention of lytic complications in myeloma which may similarly or equally be true for other bone metastases-inducing solid tumors.
Subject(s)
Antineoplastic Agents/therapeutic use , Bone Diseases/diagnosis , Bone Diseases/drug therapy , Immunologic Factors/therapeutic use , Multiple Myeloma/diagnosis , Multiple Myeloma/drug therapy , Tomography, X-Ray Computed/methods , Bone Diseases/etiology , Humans , Magnetic Resonance Imaging/methods , Multiple Myeloma/complicationsSubject(s)
Hodgkin Disease , Hypercalcemia , Parathyroid Hormone-Related Protein/blood , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Bone and Bones/pathology , Hodgkin Disease/blood , Hodgkin Disease/complications , Hodgkin Disease/drug therapy , Hodgkin Disease/pathology , Hodgkin Disease/physiopathology , Humans , Hypercalcemia/blood , Hypercalcemia/etiology , Leukemic Infiltration , Male , Middle Aged , Remission Induction , Renal Insufficiency/blood , Renal Insufficiency/etiologyABSTRACT
Between 1971 and 1986, 20 Nigerian children (less than 1 year to 15 years of age) with craniopharyngiomas were treated at the University College Hospital (UCH) in Ibadan. The children made up 71% of all patients with craniopharyngiomas seen in the hospital during the study period. The mean age of the 12 boys and 8 girls was 9.2 years. The predominant symptoms and signs were raised intracranial pressure and visual disturbance. Characteristic radiological features occurred in over 60% of cases; about two-thirds of the tumors were cystic. The advanced tumor stage upon arrival at UCH limited the amount of radical surgery that could be done; 31% died soon after surgery.