Multiple Myeloma and Other Plasma Cell Neoplasms by Meletios A. Dimopoulos Thierry Facon & Evangelos Terpos

Author:Meletios A. Dimopoulos, Thierry Facon & Evangelos Terpos
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

Patients with Asymptomatic Myeloma (AMM)

Intravenous PAM (60–90 mg monthly for 12 months) in patients with AMM reduced bone involvement at progression but did not decrease the risk and increase the time to progression (D’Arena et al. 2011). Similarly, intravenous ZOL (4 mg monthly for 12 months) reduced the SRE risk at progression but did not influence the risk of progression of AMM patients (Musto et al. 2008).

Several studies have reported the value of MRI (presence of >1 focal lesion and presence of diffuse pattern of marrow infiltration) in detecting patients with AMM at high risk for progression (Moulopoulos et al. 1995; Hillengass et al. 2010). Since there is no data supporting PFS advantage with bisphosphonates in AMM, bisphosphonates should not be recommended except for a clinical trial of high-risk patients.

Patients with MGUS

MGUS patients are at high risk for developing osteoporosis and pathological fractures (Bida et al. 2009; Kristinsson et al. 2010). Three doses of ZOL (4 mg intravenously every 6 months) increased bone mineral density (BMD) by 15% in the lumbar spine and by 6% in the femoral neck in MGUS patients with osteopenia or osteoporosis (Berenson et al. 2008). Oral alendronate (70 mg/weekly) also increased BMD of the lumbar spine and total femur by 6.1% and 1.5%, respectively, in 50 MGUS patients with vertebral fractures and/or osteoporosis (Pepe et al. 2008).

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