Experts Outline Use of Bisphosphonates Against Myeloma

Wednesday, May 23, 2007; 12:00 AM

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WEDNESDAY, May 23 (HealthDay News) -- Bone-strengthening drugs called bisphosphonates can help some patients fight the marrow cancer multiple myeloma, according to new guidelines from the American Society of Clinical Oncology.

Multiple myeloma is caused by abnormal plasma cells that form tumors in the bone marrow.

Bisphosphonates can help slow loss of bone mass, reduce bone pain and help prevent fractures. Risks associated with bisphosphonates include reduced kidney function, acute kidney failure and osteonecrosis (bone loss or deterioration) of the jaw.

Among the recommendations included in the new guidelines:

• Bisphophonates should be given to patients monthly for two years. If a patient has responded to therapy after two years, doctors should consider stopping bisphosphonate treatment. If a patient's myeloma returns, and new bone problems develop, doctors should restart bisphosphonate therapy.
• Multiple myeloma patients who experience bone loss or fracture of the spine from osteopenia should receive infusions of either 90 mg of pamidronate over two hours or 4 mg of zoledronic acid over at least 15 minutes, every three to four weeks.
• Patients receiving bisphosphonate therapy should be checked every three to six months for albuminuria -- high levels of the protein albumin in the urine that may indicate kidney damage.
• Doctors should monitor levels of creatine, a chemical in the body used to measure kidney function, before they give patients pamidronate or zoledronic acid. If patients develop kidney problems while on either of these bisphosphonates, doctors should stop treatment until the exact kidney problem is identified and resolved.
• Patients with existing kidney problems and extensive bone disease should not receive zoledronic acid. Instead, they should receive a four- to six-hour infusion of pamidronate, instead of a two-hour infusion.
• Patients with pre-existing mild to moderate kidney disease should receive reduced doses of pamidronate.
• All patients should receive a comprehensive dental examination, and all oral infections and areas in the mouth at high risk for infection should be treated before beginning bisphosphonate therapy.
• Bisphosphonate therapy should not be used in patients with: one bone tumor (solitary plasmacytoma); a slower growing form of myeloma (smoldering or indolent myeloma); conditions of abnormal plasma cells that are not myeloma but may eventually develop into myeloma.

The guidelines are expected to be published in the June 10 issue of the Journal of Clinical Oncology.

More information

The American Cancer Society has more about multiple myeloma.