Efficacy and safety of monthly low-dose denosumab for the prevention of skeletal-related events in patients with multiple myeloma: A real-world five-patient case series

Denosumab, a monoclonal antibody targeting the receptor activator of nuclear factor kappa-B ligand (RANKL), is routinely administered at a standard dose of 120 mg every 4 weeks to prevent skeletal-related events (SREs) in multiple myeloma (MM). However, evidence supporting the use of a lower 60 mg monthly dose is limited in this setting. We report a retrospective case series of five patients with relapsed or refractory multiple myeloma and pre-existing skeletal involvement who received subcutaneous denosumab 60 mg monthly alongside systemic anti-myeloma therapy. Over a follow-up period ranging from 16 to 71 months, no patient developed new SREs. Imaging demonstrated reduced metabolic activity or sclerosis of lytic lesions in 60% of patients. The renal function remained stable or improved in all cases, including those with baseline impairment, and no clinically significant hypocalcemia or denosumab-related serious adverse events were observed. These findings suggest that monthly low-dose denosumab may be a feasible and well-tolerated supportive option in selected, clinically stable multiple myeloma patients, warranting further prospective evaluation.