Functional and Pain Score Improvement with Vertebroplasty in De Novo Multiple Myeloma in a Public Institution in Mexico

Multiple myeloma a plasmatic cell disorder, characterized by bone marrow infiltration of clonal plasmatic cells, monoclonal immunoglobulin production and end stage organ damage. This disease has a wide range of clinical manifestations, including solitary disease or plasmacytoma. It´s the second most common hematologic disease just behind Non Hodgkin Lymphoma. More than 60% of de novo MM patients present vertebral involvement.

80% of MM patients refer pain as the first symptom of the disease, and this often leads to opioid abuse and adverse effects related to pain medication. Plasmocytoma is one of the three neoplastic lesions of the vertebra that can be susceptible of percutaneous vertebroplasty.

The preferred method of treatment is a percutaneous vertebroplasty (PV), a radiologic invasive treatment that can treat multiple pathologies, and is now widely used for treatment of osteoporosis vertebral fractures.

For the purpose of the study we aimed to assess functional status and reincorporation to daily living, we used the Karnofsky Performance Status; and the Barthel index. For pain improvement we used the Visual Analog Scale. The Likert satisfaction scale (introduced in 1932) measures patient satisfaction in an analog scale.

The main objective of the study was to assess the repercussion of the PV in pain score modification and improvement of functional scores in patients with MM at the Pain Clinic of the Instituto Nacional de Cancerología (INCan) in Mexico City.

We carried out the study between January 2004 and October 2015. We compared VP treatment to bisphosphonate (BP) and radiotherapy (RT) according to the visual analog scale; and according to Karnofsky and Barthel scales, we determined the reincorporation to daily activities.

We included 119 new cases con MM, of this only 64 were included in the study. Of this 54 were female, and 65 were male with a mean age of 59 years (28-87). 88% of patients referred pain as their main symptom, and 70% presented with a vertebral fracture. 26.9% had an ECOG of 3 or more. 96% (114) received RT and 99% (118) BP.

64 (54%) of patients were treated with VP. Of this, 67% referred a VAS of 4 or more (moderate to severe pain). And 92% of the patients achieved a VAS of 4 or less. As for the Karnofsky we assessed an improvement of 50/80 points pre VP to 80/90 post VP. The same result was assessed in the Barthel scale, with an improvement of 50/80 points pre VP to 80/100 post VP.

This data provides solid evidence of the importance of multidisciplinary approach, and that VP is a safe and effective treatment, coupled of course with BP and RT.