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BioMed Research International
Volume 2014, Article ID 245247, 7 pages
Clinical Study

Changes in Osteoblastic Activity in Patient Who Received Bortezomib as Second Line Treatment for Plasma Cell Myeloma: A Prospective Multicenter Study

1Division of Hematology, Department of Internal Medicine, Catholic Blood and Marrow Transplantation Center, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 137-701, Republic of Korea
2Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Republic of Korea
3Department of Hematology-Oncology, Chonnam National University Medical School, Jeollanam-do 519-763, Republic of Korea
4Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Republic of Korea
5Department of Internal Medicine, Yonsei University College of Medicine 120-752, Republic of Korea
6Department of Internal Medicine, Seoul National University College of Medicine, Seoul 110-744, Republic of Korea
7Department of Medicine, Korea University Medical Center, Seoul 136-705, Republic of Korea
8Department of Internal Medicine, Korea Cancer Center Hospital, Seoul 139-706, Republic of Korea
9Department of Internal Medicine, Pusan National University School of Medicine, Busan 602-739, Republic of Korea
10Inha University Hospital, Incheon 400-711, Republic of Korea
11Departments of Hematology/Oncology and Internal Medicine, Kosin University Gospel Hospital, Busan 602-702, Republic of Korea
12Department of Internal Medicine, Chonbuk National University Hospital, Jeonju 561-712, Republic of Korea
13Department of Internal Medicine, Inje University College of Medicine, Busan 612-896, Republic of Korea
14Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul 158-710, Republic of Korea
15Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon 310-721, Republic of Korea
16Department of Hematology-Oncology, Ajou University Hospital, Suwon 443-380, Republic of Korea
17Department of Internal Medicine, Chosun University College of Medicine, Gwangju 501-717, Republic of Korea
18Department of Internal Medicine, Dong-A University College of Medicine, Busan 602-715, Republic of Korea

Received 21 February 2014; Accepted 23 May 2014; Published 23 June 2014

Academic Editor: Dong Soon Lee

Copyright © 2014 Ki-Seong Eom et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


We conducted a prospective multicenter study identifying the role of bortezomib in patients with relapsed or refractory plasma cell myeloma (PCM) in bone resorption and formation via bone turnover markers. A total of 104 patients received at least 1 cycle of bortezomib. Most of them had advanced disease (). Among them, 75 patients completed 4 cycles of treatment. Most of the patients (81.7%) were treated in combination with steroid. After the 4th cycle treatment, 47 of 75 patients achieved CR, nCR, VGPR, and PR (64.4%), while 26 patients achieved less than PR (35.6%). The proportion of patients who achieved ≥ PR increased as patients received more treatment cycles, reaching 90% after the 8th cycle. DKK-1 levels decreased significantly posttreatment. Bone formation markers (bALP and OC) and osteoclast regulator such as sRANKL also decreased significantly. These findings were observed primarily in patients who received steroid and who had a longer disease duration. While sRANKL demonstrated significant reduction posttreatment, osteoprotegerin (OPG) level did not significantly change posttreatment, resulting in a decreased sRANKL/OPG ratio (). In conclusion, our clinical data suggest that treatment with bortezomib and steroid may rearrange the metabolic balance between osteoblast and osteoclast activities in PCM.