- Comment in:
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Mayo Clin Proc. 2007 Apr;82(4):516-7; author reply 517-8.
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Mayo Clin Proc. 2007 Jan;82(1):134; author reply 134-5.
Mayo clinic consensus statement for the use of bisphosphonates in multiple myeloma.
Lacy MQ,
Dispenzieri A,
Gertz MA,
Greipp PR,
Gollbach KL,
Hayman SR,
Kumar S,
Lust JA,
Rajkumar SV,
Russell SJ,
Witzig TE,
Zeldenrust SR,
Dingli D,
Bergsagel PL,
Fonseca R,
Reeder CB,
Stewart AK,
Roy V,
Dalton RJ,
Carr AB,
Kademani D,
Keller EE,
Viozzi CF,
Kyle RA.
Division of Hematology, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905, USA. lacy.martha@mayo.edu
Bisphosphonates are effective in the prevention and treatment of bone disease in multiple myeloma (MM). Osteonecrosis of the jaw is Increasingly recognized as a serious complication of long-term bisphosphonate therapy. Issues such as the choice of bisphosphonate and duration of therapy have become the subject of intense debate given patient safety concerns. We reviewed available data concerning the use of bisphosphonates in MM. Guidelines for the use of bisphosphonates in MM were developed by a multidisciplinary panel consisting of hematologists, dental specialists, and nurses specializing in the treatment of MM. We conclude that intravenous pamidronate and intravenous zoledronic acid are equally effective and superior to placebo in reducing skeletal complications. Pamidronate is favored over zoledronic acid until more data are available on the risk of complications (osteonecrosis of the jaw). We recommend discontinuing bisphosphonates after 2 years of therapy for patients who achieve complete response and/or plateau phase. For patients whose disease is active, who have not achieved a response, or who have threatening bone disease beyond 2 years, therapy can be decreased to every 3 months. These guidelines were developed in the Interest of patient safety and will be reexamined as new data emerge regarding risks and benefits.
PMID: 16901028 [PubMed - indexed for MEDLINE]