Management of Medication-Related Osteonecrosis of the Jaw in Multiple Myeloma Patients With Pentoxifylline and Tocopherol: Case Reports.

Medication-related osteonecrosis of the jaw (MRONJ) is a well-known side effect of bone-modifying agents such as antiresorptive medications including pamidronic and zoledronic acids (intravenous bisphosphonates) and denosumab (anti-RANK ligand humanized monoclonal antibody). The major risk factor for the precipitation of MRONJ in a patient taking antiresorptive medication is dentoalveolar trauma such as dental extractions. Management of MRONJ in oncology patients is exceptionally challenging. In this report, two multiple myeloma patients with longstanding advanced-stage MRONJ were successfully managed with combined pentoxifylline-tocopherol treatment pre- and postextraction/sequestrectomy. In conclusion, based on this report and other published reports, it appears that the use of combined pentoxifylline-tocopherol protocol in the management of MRONJ is effective.