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Research ArticleSpine

Effect of Systemic Therapies on Outcomes following Vertebroplasty among Patients with Multiple Myeloma

R.J. McDonald, J.S. McDonald, D.F. Kallmes, V.T. Lehman, F.E. Diehn, J.T. Wald, K.R. Thielen, A. Dispenzieri and P.H. Luetmer
American Journal of Neuroradiology December 2016, 37 (12) 2400-2406; DOI: https://doi.org/10.3174/ajnr.A4925
R.J. McDonald
aFrom the Departments of Radiology (R.J.M., J.S.M, D.F.K., V.T.L., F.E.D., J.T.W., K.R.T., P.H.L.)
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J.S. McDonald
aFrom the Departments of Radiology (R.J.M., J.S.M, D.F.K., V.T.L., F.E.D., J.T.W., K.R.T., P.H.L.)
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D.F. Kallmes
aFrom the Departments of Radiology (R.J.M., J.S.M, D.F.K., V.T.L., F.E.D., J.T.W., K.R.T., P.H.L.)
bNeurosurgery (D.F.K.)
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V.T. Lehman
aFrom the Departments of Radiology (R.J.M., J.S.M, D.F.K., V.T.L., F.E.D., J.T.W., K.R.T., P.H.L.)
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F.E. Diehn
aFrom the Departments of Radiology (R.J.M., J.S.M, D.F.K., V.T.L., F.E.D., J.T.W., K.R.T., P.H.L.)
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J.T. Wald
aFrom the Departments of Radiology (R.J.M., J.S.M, D.F.K., V.T.L., F.E.D., J.T.W., K.R.T., P.H.L.)
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K.R. Thielen
aFrom the Departments of Radiology (R.J.M., J.S.M, D.F.K., V.T.L., F.E.D., J.T.W., K.R.T., P.H.L.)
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A. Dispenzieri
cHematology (A.D.), College of Medicine, Mayo Clinic, Rochester, Minnesota.
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P.H. Luetmer
aFrom the Departments of Radiology (R.J.M., J.S.M, D.F.K., V.T.L., F.E.D., J.T.W., K.R.T., P.H.L.)
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    Fig 1.

    Treated and affected levels. Vertebral level frequency histograms of 287 treated vertebral levels (A) and 493 affected vertebral levels (B) in the 172 patients comprising the study population of patients with myeloma.

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    Fig 2.

    Sagittal T1 MR images demonstrating fracture types. Stars indicate treated fractures. A, Type 1 fracture, considered likely osteoporotic. Areas of preserved, high T1 signal within the fractured vertebral body, without a focal intravertebral lesion and no evidence of pedicle involvement or epidural or paraspinal disease (not shown). B, Type 2 fracture, indeterminate for underlying lesions. Diffusely low-signal marrow throughout the spine. No focal lesion or epidural or paraspinal lesion within the treated vertebral body. C, Type 3 fracture, with clear evidence of a myelomatous lesion within the treated vertebral body.

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    Fig 3.

    Diagnostic interval and duration of pain. The time interval between the diagnosis and initiation of systemic therapy (A) and the duration of pain (B) are shown as frequency histograms with each bin representing a 4-month interval.

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    Fig 4.

    Clinical outcomes. Change in median (A) and categoric (B) clinical outcome scores of pain at rest, pain with activity, and RDQ scores. Median scores are shown at preoperative baseline (preop); postoperatively (postop); and 1 week, 1 month, 6 months, and 1 year following vertebroplasty for the entire study cohort (all patients), patients not on systemic therapy at the time of vertebroplasty (untreated group) and patients on systemic therapy at the time of vertebroplasty (treated group). Median RDQ scores are shown in red; NRS pain with activity, in blue; and NRS pain at rest, in green. Categoric clinical outcomes are represented as changes in pain with rest; pain with activity; RDQ scores relative to the preoperative baseline in the immediate postoperative setting (postop); and 1 week, 1 month, 6 months, and 1 year following vertebroplasty. The fraction of patients meeting criteria for responder status are shown in green; suboptimal responder status, in yellow; and nonresponder, status in red.

Tables

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  • Comparison of demographics of patients with myeloma on systemic therapy at the time of vertebroplasty (treated group) with patients not on systemic therapy (untreated group)a

    VariableTreated Group (n = 134)Untreated Group (n = 38)
    Male sex (No.) (%)74 (55%)23 (61%)
    Deceased at 1 yr19 (14%)4 (11%)
    Duration of pain (mo)3 (1–7)2 (1–3)
    Delay in diagnosis (mo)9.5 (2.5–45)NA
    No. of affected levels5 (3–10)5 (2–12)
    No. of treated levels2 (1–3)2 (1–3)
    • Note:—NA indicates not applicable.

    • ↵a Data are median (IQR) unless otherwise indicated.

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American Journal of Neuroradiology: 37 (12)
American Journal of Neuroradiology
Vol. 37, Issue 12
1 Dec 2016
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Effect of Systemic Therapies on Outcomes following Vertebroplasty among Patients with Multiple Myeloma
R.J. McDonald, J.S. McDonald, D.F. Kallmes, V.T. Lehman, F.E. Diehn, J.T. Wald, K.R. Thielen, A. Dispenzieri, P.H. Luetmer
American Journal of Neuroradiology Dec 2016, 37 (12) 2400-2406; DOI: 10.3174/ajnr.A4925

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Effect of Systemic Therapies on Outcomes following Vertebroplasty among Patients with Multiple Myeloma
R.J. McDonald, J.S. McDonald, D.F. Kallmes, V.T. Lehman, F.E. Diehn, J.T. Wald, K.R. Thielen, A. Dispenzieri, P.H. Luetmer
American Journal of Neuroradiology Dec 2016, 37 (12) 2400-2406; DOI: 10.3174/ajnr.A4925
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