Originally published as JCO Early Release 10.1200/JCO.2007.12.1269 on May 21 2007

This Article Full Text Full Text (PDF) Journal of Oncology Practice Summary Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kyle, R. A. Articles by Anderson, K. Search for Related Content PubMed PubMed Citation Articles by Kyle, R. A. Articles by Anderson, K. Social Bookmarking                            What's this?

American Society of Clinical Oncology 2007 Clinical Practice Guideline Update on the Role of Bisphosphonates in Multiple Myeloma

Robert A. Kyle, Gary C. Yee, Mark R. Somerfield, Patrick J. Flynn, Susan Halabi, Sundar Jagannath, Robert Z. Orlowski, David G. Roodman, Patricia Twilde, Kenneth Anderson

From the Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Rochester; Minnesota Oncology Hematology, P.A., Minneapolis, MN; St Vincent's Comprehensive Cancer Center, New York, NY; Duke University Medical Center, Durham; University of North Carolina at Chapel Hill, Chapel Hill, NC; VA Pittsburgh Healthcare System, Pittsburgh, PA; and University of Nebraska Medical Center, Omaha, NE

Address reprint requests to the American Society of Clinical Oncology, 1900 Duke St, Ste 200, Alexandria, VA 22314; e-mail: guidelines{at}asco.org

Purpose To update the recommendations for the use of bisphosphonates in the prevention and treatment of bone disease in multiple myeloma. The Update Committee expanded the guideline to include a discussion of osteonecrosis of the jaw (ONJ).

Methods For the 2007 update, an Update Committee composed of members from the full panel completed a review and analysis of data published since 2002. Searches of Medline and the Cochrane Collaboration Library databases were performed.

Recommendations For multiple myeloma patients who have, on plain radiograph(s) or imaging studies, lytic destruction of bone or spine compression fracture from osteopenia, intravenous pamidronate 90 mg delivered over at least 2 hours or zoledronic acid 4 mg delivered over at least 15 minutes every 3 to 4 weeks is recommended. Clodronate is an alternative bisphosphonate approved worldwide, except in the United States, for oral or intravenous administration. New dosing guidelines for patients with pre-existing renal impairment were added to the zoledronic acid package insert. Although no similar dosing guidelines are available for pamidronate, the Update Committee recommends that clinicians consider reducing the initial pamidronate dose in patients with pre-existing renal impairment. Zoledronic acid has not been studied in patients with severe renal impairment and is not recommended in this setting. The Update Committee suggests that bisphosphonate treatment continue for a period of 2 years. At 2 years, physicians should seriously consider discontinuing bisphosphonates in patients with responsive or stable disease, but further use is at the discretion of the treating physician. The Update Committee also discusses measures regarding ONJ.

published online ahead of print at www.jco.org on May 21, 2007.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				S. Pozzi, S. Vallet, S. Mukherjee, D. Cirstea, N. Vaghela, L. Santo, E. Rosen, H. Ikeda, Y. Okawa, T. Kiziltepe, et al. High-Dose Zoledronic Acid Impacts Bone Remodeling with Effects on Osteoblastic Lineage and Bone Mechanical Properties Clin. Cancer Res., September 15, 2009; 15(18): 5829 - 5839. [Abstract] [Full Text] [PDF]

				S. N. Gebara and H. Moubayed Risk of osteonecrosis of the jaw in cancer patients taking bisphosphonates Am. J. Health Syst. Pharm., September 1, 2009; 66(17): 1541 - 1547. [Abstract] [Full Text] [PDF]

				M. N. Vogel, K. Weisel, O. Maksimovic, S. Peters, H. Brodoefel, C. D. Claussen, and M. S. Horger Pathologic Fractures in Patients With Multiple Myeloma Undergoing Bisphosphonate Therapy: Incidence and Correlation With Course of Disease Am. J. Roentgenol., September 1, 2009; 193(3): 656 - 661. [Abstract] [Full Text] [PDF]

				J. McMahan and T. Linneman A Case of Resistant Hypercalcemia of Malignancy with a Proposed Treatment Algorithm Ann. Pharmacother., September 1, 2009; 43(9): 1532 - 1538. [Abstract] [Full Text] [PDF]

				E. Terpos, O. Sezer, P. I. Croucher, R. Garcia-Sanz, M. Boccadoro, J. San Miguel, J. Ashcroft, J. Blade, M. Cavo, M. Delforge, et al. The use of bisphosphonates in multiple myeloma: recommendations of an expert panel on behalf of the European Myeloma Network Ann. Onc., August 1, 2009; 20(8): 1303 - 1317. [Abstract] [Full Text] [PDF]

				F. D. Ferris, E. Bruera, N. Cherny, C. Cummings, D. Currow, D. Dudgeon, N. JanJan, F. Strasser, C. F. von Gunten, and J. H. Von Roenn Palliative Cancer Care a Decade Later: Accomplishments, the Need, Next Steps--From the American Society of Clinical Oncology J. Clin. Oncol., June 20, 2009; 27(18): 3052 - 3058. [Abstract] [Full Text] [PDF]

				D. S. Siegel, L. McBride, E. Bilotti, N. Lendvai, J. Gonsky, T. Berges, D. Schillen, A. McNeill, L. Schmidt, and K. H. van Hoeven Inaccuracies in 24-Hour Urine Testing for Monoclonal Gammopathies: Serum Free Light Chain Analysis Provides a More Accurate Measure of Light Chain Burden Than Urine Protein Electrophoresis Lab Med, June 1, 2009; 40(6): 341 - 344. [Abstract] [Full Text] [PDF]

				A. A. KHAN, G. K.B. SANDOR, E. DORE, A. D. MORRISON, M. ALSAHLI, F. AMIN, E. PETERS, D. A. HANLEY, S. R. CHAUDRY, B. LENTLE, et al. Bisphosphonate Associated Osteonecrosis of the Jaw J Rheumatol, March 1, 2009; 36(3): 478 - 490. [Abstract] [Full Text] [PDF]

				O. Sezer Myeloma Bone Disease: Recent Advances in Biology, Diagnosis, and Treatment Oncologist, March 1, 2009; 14(3): 276 - 283. [Abstract] [Full Text] [PDF]

				A. A Saad, M. Sharma, and G. M Higa Treatment of Multiple Myeloma in the Targeted Therapy Era Ann. Pharmacother., February 1, 2009; 43(2): 329 - 338. [Abstract] [Full Text] [PDF]

				T. Van den Wyngaert, M. T. Huizing, E. Fossion, and J. B. Vermorken Bisphosphonates in Oncology: Rising Stars or Fallen Heroes Oncologist, February 1, 2009; 14(2): 181 - 191. [Abstract] [Full Text] [PDF]

				C. I. Ripamonti, M. Maniezzo, T. Campa, E. Fagnoni, C. Brunelli, G. Saibene, C. Bareggi, L. Ascani, and E. Cislaghi Decreased occurrence of osteonecrosis of the jaw after implementation of dental preventive measures in solid tumour patients with bone metastases treated with bisphosphonates. The experience of the National Cancer Institute of Milan Ann. Onc., January 1, 2009; 20(1): 137 - 145. [Abstract] [Full Text] [PDF]

				M. A. Dimopoulos, E. Kastritis, C. Bamia, I. Melakopoulos, D. Gika, M. Roussou, M. Migkou, E. Eleftherakis-Papaiakovou, D. Christoulas, E. Terpos, et al. Reduction of osteonecrosis of the jaw (ONJ) after implementation of preventive measures in patients with multiple myeloma treated with zoledronic acid Ann. Onc., January 1, 2009; 20(1): 117 - 120. [Abstract] [Full Text] [PDF]

				A. Badros, E. Terpos, E. Katodritou, O. Goloubeva, E. Kastritis, E. Verrou, K. Zervas, M. R. Baer, T. Meiller, and M. A. Dimopoulos Natural History of Osteonecrosis of the Jaw in Patients With Multiple Myeloma J. Clin. Oncol., December 20, 2008; 26(36): 5904 - 5909. [Abstract] [Full Text] [PDF]

				J. R. Berenson, O. Yellin, R. V. Boccia, M. Flam, S.-F. Wong, O. Batuman, M. M. Moezi, D. Woytowitz, H. Duvivier, Y. Nassir, et al. Zoledronic Acid Markedly Improves Bone Mineral Density for Patients with Monoclonal Gammopathy of Undetermined Significance and Bone Loss Clin. Cancer Res., October 1, 2008; 14(19): 6289 - 6295. [Abstract] [Full Text] [PDF]

				E. Terpos and M.-A. Dimopoulos Genetic predisposition for the development of ONJ Blood, October 1, 2008; 112(7): 2596 - 2597. [Full Text] [PDF]

				J. F. San Miguel, R. Schlag, N. K. Khuageva, M. A. Dimopoulos, O. Shpilberg, M. Kropff, I. Spicka, M. T. Petrucci, A. Palumbo, O. S. Samoilova, et al. Bortezomib plus Melphalan and Prednisone for Initial Treatment of Multiple Myeloma N. Engl. J. Med., August 28, 2008; 359(9): 906 - 917. [Abstract] [Full Text] [PDF]

				X. Li and L. K. McCauley Osteonecrosis of the Jaw: Meeting Report from Skeletal Complications of Malignancy V: October 25-27, 2007 in Philadelphia, Pennsylvania, USA IBMS BoneKEy, August 1, 2008; 5(8): 289 - 293. [Full Text] [PDF]

				A. Khan Bisphosphonate-associated osteonecrosis of the jaw Can Fam Physician, July 1, 2008; 54(7): 1019 - 1021. [Full Text] [PDF]

				N. Raje, S.-B. Woo, K. Hande, J. T. Yap, P. G. Richardson, S. Vallet, N. Treister, T. Hideshima, N. Sheehy, S. Chhetri, et al. Clinical, Radiographic, and Biochemical Characterization of Multiple Myeloma Patients with Osteonecrosis of the Jaw Clin. Cancer Res., April 15, 2008; 14(8): 2387 - 2395. [Abstract] [Full Text] [PDF]

				T. B. Dodson, N. S. Raje, P. A. Caruso, and A. E. Rosenberg Case 9-2008 -- A 65-Year-Old Woman with a Nonhealing Ulcer of the Jaw N. Engl. J. Med., March 20, 2008; 358(12): 1283 - 1291. [Full Text] [PDF]

				G. D. Roodman Skeletal Imaging and Management of Bone Disease Hematology, January 1, 2008; 2008(1): 313 - 319. [Abstract] [Full Text] [PDF]

				J. A. Katzel, P. Hari, and D. H. Vesole Multiple Myeloma: Charging Toward a Bright Future CA Cancer J Clin, September 1, 2007; 57(5): 301 - 318. [Abstract] [Full Text] [PDF]