P-154: Multidisciplinary, patient-centric bone disease management in multiple myeloma – A single-centre experience

Introduction: Bone disease is a prevalent issue affecting up to 80% of patients with multiple myeloma (MM) either at the time of diagnosis or during the disease progression. The frequency of detecting bone lesions varies depending on the imaging techniques employed, with more advanced cross-sectional methods like MRI or PET CT enabling earlier diagnosis. Managing the consequences of myeloma bone disease, such as bone pain, spinal cord compression, nerve root impingement from vertebral collapse, or fractures, necessitates a comprehensive, patient-centered approach. This approach involves a multidisciplinary team consisting of hematologists, radiation oncologists, orthopedic or spinal surgeons, interventional radiologists, nuclear medicine physicians, palliative care specialists, specialist nurses, and rehabilitation experts. We aim to share our experience in establishing a multidisciplinary team (MDT) for managing myeloma bone disease and the resulting outcomes for patients.

Methods: Our approach begins with identifying patients with newly diagnosed or relapsed MM with symptomatic bone manifestations. These individuals are seen concurrently by a hematologist, palliative care and radiation oncologist, and specialist nurses to optimize pain management with steroids, chemotherapy, and analgesia. Subsequently, their cases are deliberated upon in an MDT tumor board, where their imaging scans are reviewed to determine if intervention by orthopedic surgeons or interventional radiologists can be offered for optimal pain control and functional recovery. Following stabilization of the bones and optimal pain control, patients requiring further rehabilitation undergo an assessment by our oncology rehabilitation specialists. They receive tailored rehabilitation programs, either as inpatients or outpatients, aimed at optimizing their functional abilities.

Results: Between January 2023 and April 2024, a total of 23 patients, with a median age of 71 (range 26-82 years), were evaluated in this pathway. All patients received analgesia for pain management. Of these, 6 patients underwent open surgery for fracture fixation, 11 patients underwent kyphoplasty or vertebroplasty by interventional radiologists (IR), and 4 patients received radiation therapy in addition to surgical/IR interventions. Upon discharge, all patients showed improvement in ECOG performance status and pain scores, with the median Eastern Cooperative Oncology Group (ECOG) performance status score decreasing from 3 at the time of referral to 2 at discharge. Additionally, there was subjective reporting of reduced pain scores and high patient satisfaction.

Conclusions: This pathway underscores the significance of personalized bone care, recognizing the unique nature of each bone manifestation and the need for a multifaceted approach. Future endeavors will focus on quantifying the benefits through quality of life assessments and examining the long-term outcomes of patients who underwent MDT care.