Blood 2013-10-24
The impact of response on bone-directed therapy in patients with multiple myeloma.
Abstract
Significant benefits for zoledronic acid (ZOL) over clodronate acid (CLO) were seen in the Medical Research Council Myeloma IX randomized trial. ZOL significantly reduced skeletal-related events (SREs), and improved progression-free survival and overall survival (OS), making it the bisphosphonate of choice for newly diagnosed myeloma patients. In this analysis of Myeloma IX data, we have investigated the impact of response on bone disease in 1111 transplant-eligible patients. At posttransplant day 100, complete response (CR) was seen in 48% of patients, very good partial response (VGPR) in 20%, and partial response (PR) in 23%. For patients in VGPR or less, ZOL was superior to CLO in reducing SREs (P = .048), whereas for patients in CR, both agents were equivalent (P = .83). For OS, ZOL was associated with a significant benefit in patients in PR (P = .0091). No difference in OS was seen with patients in CR (P = .91) or VGPR (P = .74). These findings indicate that response category posttransplant may influence the impact of bisphosphonate therapy.
Related Questions
Is there any antiresorptive therapy that you would be comfortable prescribing if the patient refuses to see a dentist for clearance and is at risk of skeletal-related events?
For patients with hypercalcemia of malignancy, I don't usually worry about dental care. For everyone else, short answer is no.The "secret" about anti-resorptive therapy is that it provides clear benefits in patients that have myeloma that is not well-controlled (PMID 8559201, 9469347). Things become...
How long should we treat patients with newly diagnosed myeloma with bisphosphonates or RANKL inhibitors for their myeloma bone disease given recent data?
The excellent context within the question by @Dr. First Last answers 99% of what I was going to say. This is the MAGNOLIA trial that prompted this question:Lund et al., PMID 38622134 This was a randomized trial of 2 versus 4 years of zoledronic acid in myeloma. Of the 30 cases of bone lesions they f...
Do you resume zoledronic acid or denosumab at relapse in multiple myeloma?
This is generally a data free zone. Remember at induction, the overall survival benefit with Zometa is ONLY in patients with myeloma bone disease achieving less than a partial response to induction. The skeletal related event (SRE) risk reduction compared to placebo was dependent on myeloma control ...
Do you routinely offer a bisphosphonate or denosumab to multiple myeloma patients without skeletal lesions?
Our practice is to give 2 years of bone-directed therapy in all comers. Preferably bisphosphonates over denosumab for cost reasons unless needed due to CKD or intolerance.I agree that the case is less compelling for patients without skeletal lesions at baseline. An old RCT of bisphosphonates versus ...