Treatment with carfilzomib plus dexamethasone improves bone health in patients with relapsed/refractory multiple myeloma (RRMM), according to research published in Cancers.

Myeloma bone-related disease is associated with quality of life and survival for patients with RRMM. Carfilzomib plus dexamethasone has improved outcomes for patients with myeloma, but its effects on bone health haven’t been broadly reported.

This prospective, non-interventional study assessed skeletal-related events (SREs) and bone metabolism in 25 patients with RRMM who received the combination therapy. Patients in the study had received a median of 3 prior therapies. A total of 72% of patients had evidence of osteolytic bone disease when they entered the study. Patients did not receive any bone-targeted agent during the study period.

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SREs evaluated included pathological fractures, spinal canal compression, and bone-related complications that required surgery or radiotherapy. A total of 7 patients (28%) had a new SRE during treatment with carfilzomib plus dexamethasone.

The study compared markers of bone formation in RRMM patients to matched controls and found that RRMM patients had lower levels of markers of bone formation and higher levels of markers of bone resorption.

All patients experienced a reduction in markers of bone resorption levels, including C-terminal cross-linking telopeptide of collagen type I (CTX) and tartrate-resistant acid phosphatase 5b (TRACP-5b). Almost all patients also showed increases in markers of bone formation. Improvements in bone health were clinically relevant for the majority of patients and occurred regardless of response to treatment.

The study was limited by its small patient size and bone indices were evaluated only during the treatment period with carfilzomib plus dexamethasone. Overall, most patients in the study did not experience SREs during treatment, and the treatment reduced bone resorption and increased bone formation. These results suggest this treatment could improve quality of life by restoring bone health in the absence of other bone-targeting agents.

Disclosure: Several study authors declared affiliations with the biotech or pharmaceutical industries. Please see the original reference for a full list of authors’ disclosures.


Terpos E, Ntanasis-Stathopoulos I, Katodritou E, et al. Carfilzomib improves bone metabolism in patients with advanced relapsed/refractory multiple myeloma: results of the CarMMa study. Cancers (Basel). 2021;13(6):1257. doi:10.3390/cancers13061257