The International Myeloma Working Group (IMWG) recommends intravenous zoledronic acid as first-line therapy and intravenous pamidronate as second-line therapy for all patients being treated for multiple myeloma, regardless of imaging findings.1 These drugs are given monthly for 2 years and can be discontinued at 2 years if complete response or very good partial response is achieved. It is not clear how long to continue bisphosphonate treatment for patients with a partial response. ■
1. Terpos E, Morgan G, Dimopoulos MA, et al: International Myeloma Working Group recommendations for the treatment of multiple myeloma-related bone disease. J Clin Oncol 31:2347-2357, 2013.
Bone health is critical in patients with multiple myeloma, since up to 85% will suffer bone damage. Options for management include two FDA-approved bisphosphonates—pamidronate and zoledronic acid—and possibly the RANK-L inhibitor denosumab (Xgeva, investigational use).
Importance of Supportive...