What I wish I knew about Multiple Myeloma treatments 25 years later...

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Osteonecrosis of the Jaw- ONJ- Therapies for Multiple Myeloma Survivors

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“The management of bisphosphonate-related osteonecrosis of the jaws (ONJ) for MM patients,  is challenging and controversial. At present, there is no established medication treatment for the disease.”

Dear David- After Jennifer’s success with multiple myeloma (Jen reached complete remission) she is now visiting the dark side of the moon. She began having infections from a particular tooth that continued even after a root canal.

Now her doctors tell us she will eventually have that tooth removed and she will face a high probability of necrosis of the jaw. After all this time of celebrating her victory over multiple myeloma we are reeling with what is a horrible side effect.  

Never thought about this until recently. Let me know if you have any ideas.
Thanks for your support- Edwin

Hi Edwin-
You and Jen should celebrate Jen’s complete remission. I mentioned the MM roller coaster (the ups and downs during your lifes as a MM survivor and MM caregiver) at the beginning. I understand that it is difficult to endure the highs and lows of MM.
ONJ can be a vexing side effect of bisphosphonate therapy but there may be therapies to address the issue. It is difficult to appear to criticize your doctors but understand that it is a lot to expect conventional oncology to understand evidence-based non-conventional therapies like the one’s discussed below for a side effect such as ONJ.
This is a side effect that should be discussed in Beating Myeloma. There may be other MM survivors who have more to add regarding this difficult side effects.
Please consider these therapies before Jan undergoes the removal of the tooth.
David Emerson
  • MM Survivor
  • MM Cancer Coach
  • Director PeopleBeatingCancer

Recommended Reading:

“Osteonecrosis of the jaw may be caused by radiation, medication, or infection. Optimal therapy requires a multimodal approach that combines surgery with adjuvant treatments. This review focuses on the use of adjunctive hyperbaric oxygen therapy for this condition.
In addition to evidence regarding the basic and clinical science behind hyperbaric oxygen therapy, controversies in the field and economic implications are discussed.”

Successful treatment of advanced bisphosphonate-related osteonecrosis of the mandible with adjunctive teriparatide therapy.

“The management of bisphosphonate-related osteonecrosis of the jaws (ONJ) is challenging and controversial. At present, there is no established medication treatment for the disease.

METHODS: A 78-year-old osteoporotic woman with osteonecrosis of the mandible related to alendronate therapy was referred for treatment. The disease was unresponsive to conservative therapy, including antibacterial mouth rinse, antibiotics, and minor surgical debridement. Teriparatide, a human recombinant pararthyroid hormone peptide 1-34, was then used for treatment.

RESULTS: The oral mucosa completely regrew, and pain subsided 4 weeks after the initiation of teriparatide administration. Progressive bone regeneration was found during and after the 6-month period of teriparatide therapy.

CONCLUSION: Our case demonstrated that teriparatide can be an important adjuvant in the management of advanced ONJ and should be considered prior to major resection with reconstruction. Its true value in the treatment of ONJ for noncancer patients with osteoporosis warrants future studies.

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