Bone disease in myeloma |
| |
Authors: | Berenson J R |
| |
Institution: | (1) Cedars-Sinai Medical Center, University of California, Los Angeles School of Medicine, 8700 Beverly Boulevard, 90048 CA, Los Angeles, USA |
| |
Abstract: | Opinion statement The major clinical manifestation of multiple myeloma results from osteolytic bone destruction. The only currently Food and
Drug Administration-approved drug for the treatment of the bony complications of multiple myeloma is monthly intravenous pamidronate
at a dose of 90 mg infused over 4 hours. Recent studies have shown the safety of 2-hour infusions. A randomized trial comparing
pamidronate to placebo continued to show benefits throughout the 21-month trial. Although the duration of therapy has not
been firmly determined, it is likely that discontinuation of this drug will be met by enhanced bone loss and an increased
risk of bony complications for these patients. Thus, it is recommended that the drug be continued indefinitely. Support for
this recommendation also comes from the reduced bone density observed in women with postmenopausal osteoporosis following
the withdrawal of bisphosphonate treatment. Recent attempts to give higher doses, more frequent infusions (every 2 weeks or
less), or more rapid infusions (1 hour or less) of pamidronate have occasionally been associated with albuminuria and azotemia.
These modifications should therefore be avoided. Importantly, the drug can be safely administered at 90 mg monthly to patients
with poor renal function. The use of pamidronate for myeloma patients without lytic bone involvement or with Durie-Salmon
stages I or II disease has not been evaluated. However, it is recognized that most patients with earlier stages of disease
or without lytic bone involvement also develop bony complications. There is no reason to believe that these patients would
not benefit from monthly intravenous infusions of pamidronate. The potential antimyeloma effect of this agent is another reason
to administer this drug in these types of patients. Thus, it is our practice to administer monthly pamidronate to myeloma
patients regardless of stage or bone involvement. However, trials evaluating oral bisphosphonates have produced inconsistent
clinical results, probably as a result of the erratic and scanty poor absorption as well as poor oral tolerability of these
drugs. Although these oral agents may be useful in some patients, it is impossible to identify which myeloma patients will
benefit from orally administered bisphosphonates. The more potent nitrogen-containing bisphosphonate zoledronic acid more
effectively reverses hypercalcemia of malignancy than pamidronate, and it appears promising in reducing bone loss in cancer
patients. However, its efficacy in preventing skeletal complications is still being evaluated. Many other types of new agents
are in early clinical trials, but their efficacy remains unproven at the present time. |
| |
Keywords: | |
本文献已被 PubMed SpringerLink 等数据库收录! |
|