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Bone disease in myeloma.

J R Berenson1

  • 1Cedars-Sinai Medical Center, University of California, Los Angeles School of Medicine, 8700 Beverly Boulevard, Los Angeles, CA 90048, USA.

Current Treatment Options in Oncology
|June 12, 2002
PubMed
Summary

Monthly intravenous pamidronate is recommended indefinitely for multiple myeloma patients to prevent bone loss and complications. Avoid rapid infusions or higher doses due to potential kidney issues.

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Area of Science:

  • Oncology
  • Pharmacology
  • Bone Metabolism

Background:

  • Multiple myeloma frequently causes osteolytic bone destruction.
  • Pamidronate is the only FDA-approved drug for treating bone complications in multiple myeloma.
  • Current standard treatment involves monthly 90 mg intravenous pamidronate infusions over 4 hours.

Purpose of the Study:

  • To review the efficacy and safety of pamidronate for managing bone complications in multiple myeloma.
  • To provide recommendations on the optimal duration, dosage, and administration of pamidronate.
  • To discuss the potential benefits of pamidronate in earlier stages of multiple myeloma and its antimyeloma effects.

Main Methods:

  • Review of recent studies and randomized trials comparing pamidronate to placebo.
  • Analysis of safety data regarding infusion rates, dosage adjustments, and renal function.
  • Evaluation of clinical trial results for oral bisphosphonates and other emerging agents.

Main Results:

  • Pamidronate demonstrated sustained benefits in preventing bone loss and complications over a 21-month trial.
  • Shorter infusion times (2 hours) were found to be safe.
  • Higher doses, more frequent, or rapid infusions were associated with adverse renal effects (albuminuria, azotemia).
  • Pamidronate can be safely administered to patients with impaired renal function.
  • Oral bisphosphonates showed inconsistent results due to poor absorption and tolerability.
  • Zoledronic acid shows promise but requires further evaluation for skeletal complication prevention.

Conclusions:

  • Indefinite continuation of monthly intravenous pamidronate is recommended for multiple myeloma patients to prevent skeletal morbidity.
  • Pamidronate should be administered at 90 mg monthly, avoiding modifications that increase renal toxicity risk.
  • The drug is likely beneficial for all stages of multiple myeloma, including those without overt bone involvement, due to potential antimyeloma effects.

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