Abstract
ABSTRACT Background : Detection of lytic bone lesions is crucial in the workup for multiple myeloma (MM) and very often dictates the decision to start treatment. Modern imaging techniques such as MRI, PET, and CT offer superior detection of myeloma bone disease and extramedullary manifestations of plasma cell dyscrasias. Autologous stem cell transplant (ASCT) is regarded as frontline therapy in candidate patients. Recent advances in understanding of myeloma bone disease showed that the receptor activator of nuclear factor kappa-B ligand (RANKL) and osteoprotegerin (OPG) system plays a key role in this regard. Objectives : to assess the response of bone disease in patients with multiple myeloma using whole body low dose CT (WBLD CT) scan after different modalities of treatment including autologous stem cell transplant. Patients and method : This is a prospective cohort study in which patients with multiple myeloma had baseline WBLD CT scan with basic evaluation. They were then received induction chemotherapy with and then grouped into two groups according to the modality of consolidation (ASCT vs no ASCT). Both groups had second WBLD CT and were compared for the osteolytic lesions concerning size and site. Results : 20 patients were included in the study (12 males, 8 females), 8 treated with chemotherapeutic protocols (mainly bortezomib based) (group A) while 12 patients underwent ASCT during their course of treatment (group B). The improved score was found only in two patients, one in each group. Conclusion : myeloma bone disease needs to be assessed initially and promptly prevented and treated since it increases morbidity and mortality. Using newer imaging modalities like WBLD CT, MRI, PET scan is encouraged over conventional X ray skeletal survey.
