Multiple Myeloma Coverage from Every Angle

Updated ASCO Guideline for Use of Bone-Modifying Agents in Multiple Myeloma

By: Joseph Fanelli
Posted: Thursday, May 3, 2018

Patients with lytic disease on plain radiographs or imaging studies, those with osteopenia in the absence of lytic disease, and patients with monoclonal gammopathy of undetermined significance are among the few groups recommended to receive bone-modifying agents, according to a new guideline update released by the American Society of Clinical Oncology (ASCO). The latest guideline update, published in the Journal of Oncology Practice, is intended to inform oncologists, hematologists, other health-care practitioners, patients, and caregivers about the role of bone-modifying agents in patients with multiple myeloma. The guideline update was authored by Kenneth Anderson, MD, of the Dana-Farber Cancer Institute, Boston, and colleagues.

Among the guideline update are new indications to initiate bone-modifying agents, which include using agents as an adjunct to pain control for patients with pain from osteolytic disease and for those receiving other interventions for fractures or impending fractures. Another indication is for patients who have myelomas with normal plain radiographs or osteopenia in bone mineral density measurements.

For dose and selection of agent, the panel added guidelines for patients with preexisting renal impairment to the zoledronic acid package insert. Patients with preexisting mild-to-moderate renal impairment should receive a reduced dosage of zoledronic acid. Denosumab may also be an option for those with compromised renal function. Researchers found that 90 mg of pamidronate should be administered over 4 to 6 hours for patients with extensive bone disease and existing severe renal impairment or an estimated creatinine clearance < 30 mL/min.

As for duration of therapy, the panel recommends that bone-targeted treatment continue for up to 2 years, with less-frequent dosing for patients with responsive or stable disease.

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