OncohematologyOncohematologyОнкогематология1818-83462413-4023Publishing House ABV Press69410.17650/1818-8346-2008-0-1-2-58-62HEMATOLOGIC MALIGNANCIES: DIAGNOSIS, TREATMENT, SUPPORTIVE CAREГЕМОБЛАСТОЗЫ: ДИАГНОСТИКА, ЛЕЧЕНИЕ, СОПРОВОДИТЕЛЬНАЯ ТЕРАПИЯTreatment of bone complications in multiple myeloma patientsЛечение скелетных осложнений у пациентов с множественной миеломойPtushkinV. V.ПтушкинВ. В.
Russian Federation
Department of adolescent and adult hematology and oncology of Federal State Enterprise «Federal Research Clinical Center of Pediatric Hematology, Oncology and Immunology of Russian Public HealthОтдел подростковой и возрастной гематологии и онкологии ФГУ «Федеральный научный клинический центр детской гематологии, онкологии и иммунологии» Росздрава230520081-2586223112022231120222008https://oncohematology.abvpress.ru/ongm/article/view/694

Multiple myeloma frequently leads to bone complications characterized by the presence of lytic defects with high incidence of pathologic fractures, hypercalcemia and osteoporosis. The basic cause of this effect lies in the ability of malignant plasmatic cells to stimulate osteoclasts which are cells participating in the process of resorption of osseous tissue. Increased resorption of osseous matrix by means of osteoclasts activation runs concurrently with the process of decrease of activity of osteoblasts which are cells synthesizing osseous matrix of the bones. It has been a long time since the efforts to cope with consequences of unfavorable influence of myeloma cells on osseous tissue has been under way mainly by symptomatic means: local radiotherapy, surgical reconstruction of the bone, especially in cases of vertebral involvement, and anesthesia. Recently new weapon has been added to the arsenal for treatment of bone complications: bisphosphonates which are agents inhibiting the activity of osteoclasts and thus promoting the consolidation of the bones. Results of controlled clinical trials showed that such a medications as clodronate, pamidronate and zoledronate considerably decrease the incidence of bone complications in patients with multiple myelomas. Pamidronate and xoledronate turned out to be more active, at the same time long term usage of zoledronic acid can lead to development of such an adverse complication as osteonecrosis of jaw. The ASCO recommendations indicates the appropriateness of long term use of pamidronate or zoledronate in patients with multiple myelomas and bone complications.

Миеломная болезнь часто приводит к скелетным осложнениям — литическим дефектам с патологическими переломами, гиперкальциемии и остеопорозу. В основе этого действия опухолевых плазматических клеток лежит их способность стимулировать остеокласты — клетки осуществляющие резорбцию костной ткани. Повышенная резорбция костного матрикса за счет активации остеокластов протекает одновременно со снижением активности клеток синтезирующих костный матрикс клеток — остеобластов.Долгие годы борьба с последствиями неблагоприятного воздействия клеток миеломы на костную ткань проходила в русле сиптоматической помощи — местная лучевая терапия, хирургическая реконструкция кости, особенно при поражениях позвоночника и обезболивание. В последние годы к этому арсеналу добавились бисфосфонаты — группа препаратов, тормозящих активность остеокластов и способствующих укреплению костной ткани. Результаты контролируемых исследований показали, что такие препараты как клодронат, памидронат и золедронат, значимо снижают вероятность костных осложнений у больных множественной миеломой. Памидронат и золедронат оказались наиболее активными, но при этом длительное использование золедроновой кислоты чаще приводило к развитию такого неблагоприятного осложнения, как остеонекроз челюсти. В рекомендациях ASCO указывается на целесообраность длительного использования памидроната или золедроната у больных с миеломной болезнью и скелетными осложнениями.

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