strontium-radioisotopes and Multiple-Myeloma

Osteosclerotic myeloma is a rare disorder characterized by paraproteinaemia and osteosclerosis, and may be associated with a progressive peripheral neuropathy. Patients with widespread osteosclerotic lesions can succumb from neurological complications despite systemic chemotherapy. We present a case of disseminated osteosclerotic myeloma associated with POEMS (peripheral neuropathy, organomegaly, endocrinopathy, M band, skin changes) syndrome, which was complicated by a rapidly progressive, life-threatening neuropathy. The patient's symptoms remained unchanged in the face of combination chemotherapy. However, a substantial improvement was seen following outpatient treatment with the commonly available radioisotope strontium 89 in combination with steroids.

Topics: Anti-Inflammatory Agents; Combined Modality Therapy; Disease Progression; Humans; Male; Middle Aged; Multiple Myeloma; Osteosclerosis; POEMS Syndrome; Prednisolone; Radiopharmaceuticals; Strontium Radioisotopes

Strontium-89 is an effective agent for palliation of pain due to bony metastases from breast and prostate carcinoma. As a functional analog of calcium, 89Sr is taken up by bone in areas of osteoblastic activity. Since patients with multiple myeloma frequently have osteolytic metastases, 89Sr might not be considered to be a therapeutic option. However, metastases which appear osteolytic by radiographs may demonstrate osteoblastic activity on bone scans. Consequently, the bone scan may be used to identify a subset of patients with osteolytic metastases who may benefit from 89Sr treatment. This report describes a patient with severe rib pain due to multiple myeloma whose chest radiograph showed multiple lucent lesions throughout the bones of the chest wall but whose bone scan showed marked osteoblastic activity. The patient was treated with 89Sr and received substantial pain relief. Bone scans may be useful in selecting myeloma patients or other cancer patients with osteolytic radiographic lesions who may benefit from 89Sr therapy.

Topics: Bone and Bones; Bone Neoplasms; Female; Follow-Up Studies; Humans; Middle Aged; Multiple Myeloma; Radionuclide Imaging; Strontium Radioisotopes; Technetium Tc 99m Medronate

Topics: Bone Neoplasms; Chondroblastoma; Chondroma; Diphosphates; Evaluation Studies as Topic; Giant Cell Tumors; Humans; Multiple Myeloma; Osteoma, Osteoid; Radionuclide Imaging; Sarcoma; Strontium Radioisotopes; Technetium; Technetium Tc 99m Pyrophosphate

Scanning is based on the uptake of a nuclide by the crystal lattice of bone and is related to bone blood flow. Cancer cells do not take up the tracer. Normally, the scan visualizes the highly vascular bones. Scans are useful and are indicated in metastatic bone disease, primary bone tumors, hematologic malignancies and some non-neoplastic diseases. The scan is more sensitive than x-ray in the detection of malignant diseases of the skeleton.

Topics: Adult; Bone Diseases; Bone Neoplasms; Child; Diagnosis, Differential; Evaluation Studies as Topic; Femoral Fractures; Fluorine; Humans; Lymphoma; Multiple Myeloma; Neoplasm Metastasis; Osteitis Deformans; Osteosarcoma; Pelvic Bones; Phosphates; Radiography; Radioisotopes; Radionuclide Imaging; Skull Neoplasms; Strontium Isotopes; Strontium Radioisotopes; Technetium

Topics: Aged; Female; Humans; Immunoglobulin A; Immunoglobulin G; Male; Middle Aged; Multiple Myeloma; Myeloma Proteins; Osteoporosis; Pain; Radiography; Skull; Spine; Strontium Radioisotopes

Topics: Adolescent; Adult; Bone Neoplasms; Chondroma; Female; Fibrous Dysplasia of Bone; Giant Cell Tumors; Humans; Male; Middle Aged; Multiple Myeloma; Radionuclide Imaging; Strontium Radioisotopes

Topics: Acid Phosphatase; Adult; Aged; Alkaline Phosphatase; Bone Neoplasms; Bone Resorption; Breast Neoplasms; Female; Hematologic Diseases; Humans; Injections, Intravenous; Male; Middle Aged; Movement; Multiple Myeloma; Neoplasm Metastasis; Pain, Intractable; Radionuclide Imaging; Remission, Spontaneous; Strontium Radioisotopes; Urinary Bladder Neoplasms; Uterine Neoplasms

Topics: Humans; Multiple Myeloma; Neoplasms; Phosphorus; Phosphorus Radioisotopes; Radioisotopes; Strontium; Strontium Radioisotopes