**Author details**

Mariam Boota1 , Joshua Bornhorst2 , Zeba Singh2 and Saad Z. Usmani1\*

\*Address all correspondence to: susmani@uams.edu

1 Myeloma Institute for Research & Therapy, University of Arkansas for Medical Sciences, Little Rock, AR, USA

2 Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR, USA

#### **References**


[3] Nair, B, Van Rhee, F, Shaughnessy, J. D, et al. Superior results of Total Therapy 3 (2003-33) in gene expression profiling-defined low-risk multiple myeloma confirmed in subsequent trial 2006-66 with VRD maintenance. Blood. (2010). , 115(21), 4168-73.

economic implications of broader usage in clinical practice. These concerns may be alleviated may be in the future with development of more efficient and cost-effective technologies.

Our understanding of MM has grown many folds over the last 2 decades with a better understanding of the genomic heterogeneity associated with this disease. We are just begin‐ ning to combine the clinical and biologic prognostic markers in newly diagnosed multiple myeloma patients in efforts to better stratify patients and choosing appropriate therapies. There are multinational efforts, such as the CoMMpass study, aiming to provide for a com‐ prehensive understanding of the disease in the era of novel agents [66]. With the advances in drug development, we are getting closer to developing a risk-adaptive therapeutic strategy for majority of MM patients. There is a robust pipeline of novel targeted agents on the horizon for MM. It appears that there will be enough effective and tolerable therapeutic agents in the oncologist's armamentarium that the treatment strategy will take in to account both the clinical and biologic risk factors for a truly personalized medicine experience. The advances in diagnostic and prognostic tools will also provide impetus for a response-adaptive strategy which will likely be incorporated in the therapeutic matrix as the data emerges over the next

**4. Conclusion and future directions**

210 Multiple Myeloma - A Quick Reflection on the Fast Progress

, Joshua Bornhorst2

\*Address all correspondence to: susmani@uams.edu

, Zeba Singh2

1 Myeloma Institute for Research & Therapy, University of Arkansas for Medical Sciences,

2 Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR,

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decade.

USA

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**Author details**

Little Rock, AR, USA

Mariam Boota1


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**Chapter 11**

**Bone Disease in Multiple Myeloma**

Additional information is available at the end of the chapter

Torben Plesner

**1. Introduction**

http://dx.doi.org/10.5772/55190

besides their anti-myleoma effect.

Maja Hinge, Thomas Lund, Jean-Marie Delaisse and

Osteolytic bone disease in multiple myeloma (MM) is a common event. Already at diagnosis, approximately eighty percent of patients present with abnormal bone structure [1;2]. During disease progression a large proportion of patients will develop ostelytic lesions [3]. MM bone disease not only results in a reduced quality of life due to pain, pathological fractures, or symptomatic hypercalcaemia [4]; but may also be *the* deciding factor that determines if a patient requires anti-myeloma treatment or if a watch and wait strategy can be applied [5]. In this chapter we will discuss the normal bone remodelling process, and how it is affected in MM. During the last decades, increased knowledge about bone pathophysiology in general has led to an improved understanding of MM bone disease. The description of the receptor activator of nuclear factor kappa B (RANK) and its ligand in the nineties was one of the most significant steps. We will also address how biochemical markers may be used to monitor the velocity of the different processes in bone remodelling. The next part of the chapter will be dedicated to the treatment of MM bone disease. For many years, bisphosphonates have been a cornerstone in the treatment of MM bone disease and despite the occurrence of osteonecrosis of the jaw that was first report‐ ed as a result of the of bisphosphonate treatment in the early part of this century, these agents remain the most important components of treatment for MM bone disease. Lastly, we will discuss how various anti-myeloma treatments may influence bone turnover. During the last decade a number of novel drugs have been approved for the treatment of MM and especially proteasome inhibitors seems to have a positive effect on MM bone disease

> © 2013 Hinge et al.; licensee InTech. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use,

© 2013 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution,

distribution, and reproduction in any medium, provided the original work is properly cited.

and reproduction in any medium, provided the original work is properly cited.

