Mayo Clinic consensus statement for the use of bisphosphonates in multiple myeloma

Martha Q. Lacy, Angela Dispenzieri, Morie A. Gertz, Philip R. Greipp, Kimberly L. Gollbach, Suzanne R. Hayman, Shaji Kumar, John A. Lust, S. Vincent Rajkumar, Stephen J. Russell, Thomas E. Witzig, Steven R. Zeldenrust, David Dingli, P. Lief Bergsagel, Rafael Fonseca, Craig B. Reeder, A. Keith Stewart, Vivek Roy, Robert J. Dalton, Alan B. CarrDeepak Kademani, Eugene E. Keller, Christopher F. Viozzi, Robert A. Kyle

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Abstract

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 blsphosphonate 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.

Original languageEnglish (US)
Pages (from-to)1047-1053
Number of pages7
JournalMayo Clinic proceedings
Volume81
Issue number8
DOIs
StatePublished - Aug 2006

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ASJC Scopus subject areas

  • Medicine(all)

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