Intravenous pamidronate for myeloma bone disease: can the dose be lowered?

摘要

Many patients with multiple myeloma develop osteolytic lesions during the course of their disease. Such bone lesions can lead to several skeletal-related events over a patient's lifetime, resulting in substantial morbidity and increased mortality and healthcare costs. Bisphosphonates are the current standard of care for prevention of skeletal-related events in patients with myeloma. Clinical guidelines include intravenous bisphosphonates (pamidronate, 90 mg via 2-h infusion, or zoledronic acid, 4 mg via 15-min infusion, every 3-4 weeks) and oral clodronate as a key component for the management of myeloma bone disease. However, the most effective bisphosphonate and the optimum duration of bisphosphonate therapy are yet to be determined. To date, only one randomised head-to-head study has been published comparing two of the three aforementioned bisphosphonates. This study showed that intravenous pamidronate at a dose of 90 mg and 4 mg intravenous zoledronic acid, every 3-4 weeks, were equally effective for reduction of skeletal-related events in multiple myeloma patients with osteolytic disease, and that these drugs had similar toxicity. However, because of the shorter infusion time and patients' convenience, zoledronic acid has been used more extensively than pamidronate in many countries.