Treatment of painful bone lesions and hypercalcemia

The control of myeloma bone disease has been an important therapeutic problem. Bisphosphonates are potentially active for the control of myeloma bone resorption. Although several studies proved the efficacy of short-term bisphosphonate treatment in inhibiting myeloma bone destruction, data on the long-term efficacy are scanty. We present the results of a prospective pilot study for the evaluation of long-term parenteral administration of dichloromethylene bisphosphonate (Clodronate) in 30 patients with active myeloma bone disease. Patients were treated with a mean of 4 courses (range 2-8) of Clodronate: 300 mg/d i.v. for 7 days followed by 100 mg/d i.m. for 10 d, administered at a mean interval of 4 months. The median follow-up was 24 months (range 8-36). Clodronate reduced bone pain rapidly and significantly, and reduced the mean values of the biochemical indices of bone resorption to within normal limits. The occurrence of skeletal morbidity in patients treated with Clodronate was compared with that observed in the control group of myeloma patients treated with chemotherapy only: Clodronate provided a significant (p less than 0.001) reduction in severe bone pain as well as in the incidence of new osteolytic lesions and pathological fractures. The results of this prospective pilot trial indicate that supportive long-term treatment with parenteral Clodronate can contribute significantly to controlling the progression of myeloma bone disease.