Bisphosphonate Therapy Underutilized in Multiple Myeloma Bone Disease Management
Current recommendations suggest initiating intravenous bisphosphonates for multiple myeloma treatment.
Patients with multiple myeloma may not be receiving optimal therapeutic management for bone disease, according to a study published in Supportive Care in Cancer.
Current treatment recommendations suggest initiating intravenous bisphosphonates (eg, zoledronic acid, clodronate, pamidronate) for patients with multiple myeloma, not only for bone disease but also, as previous studies have demonstrated, possible benefit to overall survival and progression-free survival. The direction of treatment upon response to primary myeloma therapy and real-world use in this patient population, however, requires further investigation.
For this retrospective study, researchers collected data from 11,112 patients with multiple myeloma and evaluated the timing, frequency, schedule, change in dosing schedule, and discontinuation of zoledronic acid or pamidronate. Secondary outcomes included identifying predictors of bisphosphonate treatment initiation and to further analyze data once patients were stratified by chronic kidney disease stage.
After a median follow-up of 687 days, results showed that 63% of patients received at least 1 dose of bisphosphonate therapy; patients received first dose of bisphosphonates after a mean time of 106 days after multiple myeloma diagnosis.
Therapy was initiated within the first year of diagnosis in approximately 58% of patients, but slightly more than 50% had a change in dosing or discontinued treatment.
Patients who had poor renal function as measured by eGFR were less likely to receive bisphosphonate therapy and experienced a greater delay in therapy initiation. Therapy was initiated in 72% of patients at eGFR stage 1 vs 24% at eGFR stage 5, and treatment was initiated 25 days after diagnosis vs 70 days after diagnosis, respectively.
Kim C, Hernandez RK, Cyprien L, Liede A, Cheng PC. Patterns of bisphosphonate treatment among patients with multiple myeloma treated at oncology clinics across the USA: observations from real-world data [published online March 7, 2018]. Support Care Cancer. doi: 10.1007/s00520-018-4133-1