A 61-year-old female with progressive functional right hip pain is brought to your office by her daughter. She has recently received the diagnosis of multiple myeloma and is seeing a medical oncologist for chemotherapy and radiation to multiple lesions throughout her skeleton. She has a known myeloma lesion in the right intertrochanteric region of the femur.
Mirel criteria for risk of pathologic fracture includes all of the following parameters except:
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Size of lesion
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Location of lesion
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Characteristics of pain associated with the lesion
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Primary site of malignancy
Discussion
The correct answer is (D). Mirel score is a useful tool in the management of bone tumors and is used to identify patients who would benefit from prophylactic fixation of their bone lesion due to high enough risk of pathologic fracture. There are four criteria utilized in the scoring system: site, size, lesion characteristics, and pain characteristics. The primary source of malignancy (breast, lung, thyroid, etc.) is not included, as this has not been shown to correlate with fracture risk.
Her daughter asks about autologous stem cell transplant and overall survival with the disease.
Which of the following is the most accurate response?
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Autologous stem cell transplant is no longer performed, since newer chemotherapy agents have improved 10-year survival rate to nearly 90%
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Autologous stem cell transplant improves survival overall; still, the overall 10-year survival rate is only about 10%
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Renal failure precludes a patient’s ability to receive an autologous stem cell transplant
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Autologous stem cell transplant offers a cure for multiple myeloma
Discussion
The correct answer is (B). The overall 10-year survival rate for patients with this condition is about 10%. Median survival is 3 years and prognosis is worse with renal failure. Autologous stem cell transplant has been shown to improve survival and is currently a treatment option in addition to chemotherapy, bisphosphonates, and radiation therapy.
Objectives: Did you learn...?
To utilize Mirel scoring system to predict risk of pathologic fracture? Medical myeloma treatment and prognosis?
