of the Jaws in Myeloma在多发性骨髓瘤的颌骨坏死课件.ppt

Osteonecrosis of the Jaws in Myeloma BRIAN G.M. DURIE, M.D., Michael Katz, Jason McCoy, MS and John Crowley, PhD Hematology/Oncology, Cedars-Sinai Outpatient Cancer Center, Los Angeles, CA, USA; Web Support/Data Analysis, International Myeloma Foundation, Los Angeles, CA, USA; and Statistics, Cancer Research and Biostatistics, Seattle, WA, USA. Osteonecrosis of the Jaws – What Is It? Exposed bone in the maxilla or mandible Due to disruption of the resorption-remodeling cycle of bone and inhibition of endothelial cell proliferation Poor healing and secondary infection can lead to loss of teeth and segments of jaw bones. Pictures courtesy Dr. Sal Ruggiero How Frequent Is Osteonecrosis? Rare prior to 2001 2003 - Marx* reported 36 patients 2004 - Ruggiero** et al reported 63 patients diagnosed 2001-2003 2004/ 2005 Myeloma specialty groups report an increased frequency; 2-5% of patients at IMF seminars in Dallas/ San Diego/ LA/ Portland/ Tucson indicate osteonecrosis diagnosis * JOMF SURG 61:115 2003 ** JOMF SURG 62:527 2004 Questions About Osteonecrosis Was the diagnosis missed prior to 2001? Probably Not It is an obvious dental problem What caused the increased frequency of ONJ? Not Clear Marx and Ruggerio et al proposed an association with bisphosphonate use Important Current Questions/ Issues Is the likelihood of ONJ linked to use of Aredia and/or Zometa? To what extent do other therapies or disease processes have an impact? Are there identifiable risk factors? What is the magnitude/severity of the problem? Are myeloma patients particularly at risk for osteonecrosis (ONJ) e.g. versus breast cancer? OUR STUDY Anonymous WEB Based Survey: Summer 2004 Included 1203 Myeloma(904) and Breast Cancer (299) patients Recruited using IMF email lists/web site plus “ACOR” myeloma and breast Listservs (email), Nexcura (e