Complete Segmental Bone Resorption Followed by Complete Non-Operative Bone Restoration in the Setting of Multiple Myeloma

Advances in medical management of multiple myeloma have improved the potential for lesional bone healing, decreasing numbers of skeletal related events and need for radical surgical intervention. However, documented cases of complete lesion healing in a multiple myeloma patient are rare. In the current case, progressive post-operative lesional progression following ORIF of a subtrochanteric pathological fracture was followed by complete healing and bone restoration coincident with radiotherapy and a daratumumab based chemotherapy regimen in a patient with stage III high risk multiple myeloma. While research into the effects of daratumumab on bone healing is in its infancy, this agent demonstrates the potential to promote substantial lesional healing in multiple myeloma patients, beyond what has been demonstrated with other anti-myeloma regimens. This case is presented to raise awareness of the possibility of profound progressive bone osteolysis in myeloma and the potential for lesional healing through radiotherapy and medical management without radical surgery.