I started monthly Aredia (pamidronate) infusions when I started my treatment in 2012. After a stem cell transplant, I'm in complete remission (CR).
I continued on Aredia and now am on a 3-month cycle with no end date. I know there are side effects. My doctor wants to continue indefinitely to strengthen the bones.
Is anyone else doing the same?
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mso - Name: Mic
- Who do you know with myeloma?: self
- When were you/they diagnosed?: Sept 2010
- Age at diagnosis: 53
Re: Aredia while in remission - continue indefinitely?
I'm not on Aredia, but on Zometa infusions every 6 weeks for the last 6 years. I had a couple of vacations from the Zometa, for 4 months in preparation for ASCT and 100 days post, and for 3 months for knee surgery and recovery.
During the ASCT break, I developed a rib fracture. During the surgery break, I relapsed and developed more bone lesions, one of which became symptomatic and required radiation.
Because I have lesions everywhere and I have experienced two pathologic fractures – my left humerus 6 years ago and the rib fracture 5 years ago – my oncologist and I feel that continuing with Zometa is a wise choice.
Fortunately I haven't had any problems with the Zometa infusions themselves and haven't experienced any of the side effects that could develop with long-term use. I am constantly aware of the fact that I could have problems with long term use and report any symptoms that I have that might be the beginning of these side effects, unusual severe pain and severe dental pain. None have turned out to be because of the Zometa side effects.
I was in CR for almost 3 years post ASCT before relapsing. I had Zometa infusions for 2 1/2 years of that time that I was in CR.
Nancy in Phila
During the ASCT break, I developed a rib fracture. During the surgery break, I relapsed and developed more bone lesions, one of which became symptomatic and required radiation.
Because I have lesions everywhere and I have experienced two pathologic fractures – my left humerus 6 years ago and the rib fracture 5 years ago – my oncologist and I feel that continuing with Zometa is a wise choice.
Fortunately I haven't had any problems with the Zometa infusions themselves and haven't experienced any of the side effects that could develop with long-term use. I am constantly aware of the fact that I could have problems with long term use and report any symptoms that I have that might be the beginning of these side effects, unusual severe pain and severe dental pain. None have turned out to be because of the Zometa side effects.
I was in CR for almost 3 years post ASCT before relapsing. I had Zometa infusions for 2 1/2 years of that time that I was in CR.
Nancy in Phila
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NStewart - Name: Nancy Stewart
- Who do you know with myeloma?: self
- When were you/they diagnosed?: 3/08
- Age at diagnosis: 60
Re: Aredia while in remission - continue indefinitely?
Hi MSO,
Probably you have a good reason to still be on bisphosphonates, such as having had a lot of fractures or lesions?
Below is a reference to a review from the Annals of Oncology which describes some of the information about the bisphosphonates used in treating cancer patients, including people with myeloma. It is an article from 2006, which is almost 10 years old, but maybe that is when the bisphosphonates such as Zometa were first being used.
I took Aredia infusions for three years, but not monthly except for the first 12 - 18 months (sorry, I don't remember everything from that time), and then the infusions were spaced to every 2 months. and every 3 months. Unless I really started to need the bisphosphonates again, that is all that is recommended at my cancer centre.
What I found interesting too, in this article, is how much stronger Zometa is than Aredia, in building the bones again. It only was approved here in 2010, I think. The infusion time is much shorter for Zometa than for Aredia.
I think, though, that the Aredia did help me a lot, since I have not had any more fractures yet, and my DEXA scan taken last year on the suggestion of my family physician showed improvements.
The worry I have with taking too much of bisphosphonates is the danger of 'sheer' fractures. Even women taking Fosamax for osteopenia are worried about that issue. So I wouldn't take those drugs again unless I had a need to.
Reference:
"Management of the adverse effects associated with intravenous bisphosphonates," Annals of Oncology, June 2006 (link to full text of article)
Abstract:
Intravenous bisphosphonates are widely used to treat hypercalcemia and to reduce skeletal-related morbidity among cancer patients. However, serious complications, generally occurring in less than 2% of patients participated in phase III clinical trials, including acute systemic inflammatory reaction, ocular inflammation, renal failure, nephrotic syndrome, electrolyte imbalance, and osteonecrosis of the maxilla and mandible have all been increasingly reported. Yet, strategies to deal with these complications are becoming clear. Acute systemic inflammatory reaction is often self-limited and becomes less intense during subsequent treatments. For patients who develop ocular symptoms, prompt ophthalmologic evaluation is crucial to determine the safety of a subsequent bisphosphonate therapy. Patients who receive long-term pamidronate should be evaluated at intervals for early sign of nephritic syndrome as timely cessation of the agent may result in a full recovery. To reduce the risk of severe electrolyte abnormalities, particularly hypocalcemia, correcting any pre-treatment electrolyte abnormality and supplementing vitamin D and calcium may be helpful. Finally, to reduce the risk of osteonecrosis of the maxilla and mandible, obtaining a full dental evaluation before treatment and avoidance of invasive dental procedures is suggested. The three commonly used intravenous bisphosphonates (pamidronate, zoledronic acid, and ibandronate), are generally safe; ibandronate has to date been the least reported to be associated with renal side effects. As clinical indications of intravenous bisphosphonates continue to expand, prescribing clinicians should be familiar with these possible adverse effects and discuss them with patients before commencing or continuing on therapy.
Probably you have a good reason to still be on bisphosphonates, such as having had a lot of fractures or lesions?
Below is a reference to a review from the Annals of Oncology which describes some of the information about the bisphosphonates used in treating cancer patients, including people with myeloma. It is an article from 2006, which is almost 10 years old, but maybe that is when the bisphosphonates such as Zometa were first being used.
I took Aredia infusions for three years, but not monthly except for the first 12 - 18 months (sorry, I don't remember everything from that time), and then the infusions were spaced to every 2 months. and every 3 months. Unless I really started to need the bisphosphonates again, that is all that is recommended at my cancer centre.
What I found interesting too, in this article, is how much stronger Zometa is than Aredia, in building the bones again. It only was approved here in 2010, I think. The infusion time is much shorter for Zometa than for Aredia.
I think, though, that the Aredia did help me a lot, since I have not had any more fractures yet, and my DEXA scan taken last year on the suggestion of my family physician showed improvements.
The worry I have with taking too much of bisphosphonates is the danger of 'sheer' fractures. Even women taking Fosamax for osteopenia are worried about that issue. So I wouldn't take those drugs again unless I had a need to.
Reference:
"Management of the adverse effects associated with intravenous bisphosphonates," Annals of Oncology, June 2006 (link to full text of article)
Abstract:
Intravenous bisphosphonates are widely used to treat hypercalcemia and to reduce skeletal-related morbidity among cancer patients. However, serious complications, generally occurring in less than 2% of patients participated in phase III clinical trials, including acute systemic inflammatory reaction, ocular inflammation, renal failure, nephrotic syndrome, electrolyte imbalance, and osteonecrosis of the maxilla and mandible have all been increasingly reported. Yet, strategies to deal with these complications are becoming clear. Acute systemic inflammatory reaction is often self-limited and becomes less intense during subsequent treatments. For patients who develop ocular symptoms, prompt ophthalmologic evaluation is crucial to determine the safety of a subsequent bisphosphonate therapy. Patients who receive long-term pamidronate should be evaluated at intervals for early sign of nephritic syndrome as timely cessation of the agent may result in a full recovery. To reduce the risk of severe electrolyte abnormalities, particularly hypocalcemia, correcting any pre-treatment electrolyte abnormality and supplementing vitamin D and calcium may be helpful. Finally, to reduce the risk of osteonecrosis of the maxilla and mandible, obtaining a full dental evaluation before treatment and avoidance of invasive dental procedures is suggested. The three commonly used intravenous bisphosphonates (pamidronate, zoledronic acid, and ibandronate), are generally safe; ibandronate has to date been the least reported to be associated with renal side effects. As clinical indications of intravenous bisphosphonates continue to expand, prescribing clinicians should be familiar with these possible adverse effects and discuss them with patients before commencing or continuing on therapy.
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Nancy Shamanna - Name: Nancy Shamanna
- Who do you know with myeloma?: Self and others too
- When were you/they diagnosed?: July 2009
Re: Aredia while in remission - continue indefinitely?
MSO,
I have been on Aredia for 4 years now, initially every month for about 6 months, then every 3 months thereafter. I inquired about switching to Zometa because a clinical trial showed it may have some anti-myeloma effect, but my oncologist recommended against it because of the increased risk of jaw osteonecrosis. Maybe this is because it may cost more as well, I really do not know.
I can say Aredia has hardened my bones quite a bit. Four years ago when I had my first bone marrow aspiration and biopsy, my oncologist had to make three taps before he was able to get an aspiration and commented that my bone seemed a bit soft, which was not a good sign. I just had another bone aspiration and biopsy two days ago and this time was different. He had trouble getting a biopsy sample because my bone was so hard. He had to hammer several times in different places before he could get a sample.
Fortunately, this was not that painful, as he did a good job of numbing me, but it was kind of weird feeling the pressure of his biopsy tool hitting against my bone and him shifting around trying to find a good spot. He commented that I had some of the hardest bone he has seen in a while.
I have been on Aredia for 4 years now, initially every month for about 6 months, then every 3 months thereafter. I inquired about switching to Zometa because a clinical trial showed it may have some anti-myeloma effect, but my oncologist recommended against it because of the increased risk of jaw osteonecrosis. Maybe this is because it may cost more as well, I really do not know.
I can say Aredia has hardened my bones quite a bit. Four years ago when I had my first bone marrow aspiration and biopsy, my oncologist had to make three taps before he was able to get an aspiration and commented that my bone seemed a bit soft, which was not a good sign. I just had another bone aspiration and biopsy two days ago and this time was different. He had trouble getting a biopsy sample because my bone was so hard. He had to hammer several times in different places before he could get a sample.
Fortunately, this was not that painful, as he did a good job of numbing me, but it was kind of weird feeling the pressure of his biopsy tool hitting against my bone and him shifting around trying to find a good spot. He commented that I had some of the hardest bone he has seen in a while.
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Eric Hofacket - Name: Eric H
- When were you/they diagnosed?: 01 April 2011
- Age at diagnosis: 44
Re: Aredia while in remission - continue indefinitely?
Hi Mic,
The International Myeloma Working Group in 2013 published some recommendations related to bisphosphonate treatment in myeloma patients. The Beacon has an article that summarizes the recommendations, which you can find here:
"Experts Publish Treatment Recommendations For Multiple Myeloma-Related Bone Disease," The Myeloma Beacon, June 26, 2013.
The full text of the recommendations also can be viewed at the Journal of Clinical Oncology website.
The Beacon article summarizes the section of the recommendations related to treatment duration for Aredia and other bisphosphonates as follows:
Hope this helps a bit.
The International Myeloma Working Group in 2013 published some recommendations related to bisphosphonate treatment in myeloma patients. The Beacon has an article that summarizes the recommendations, which you can find here:
"Experts Publish Treatment Recommendations For Multiple Myeloma-Related Bone Disease," The Myeloma Beacon, June 26, 2013.
The full text of the recommendations also can be viewed at the Journal of Clinical Oncology website.
The Beacon article summarizes the section of the recommendations related to treatment duration for Aredia and other bisphosphonates as follows:
According to the experts, the evidence is less clear regarding the duration of therapy with Aredia. They therefore recommend that physician discretion determine the duration of treatment with Aredia, and that treatment be resumed at relapse.
The researchers add that the optimal treatment duration is not clear for patients who achieve a very good partial or complete response to their anti-myeloma therapy. The experts recommend, however, that these patients be treated for at least 12 months and up to 24 months and at their physicians' discretion thereafter.
Hope this helps a bit.
Re: Aredia while in remission - continue indefinitely?
I have been taking it for 6 years now. First it was monthly, but for the last 4 years once every 3 months. I do not notice any side effects.
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Ron Harvot - Name: Ron Harvot
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: Feb 2009
- Age at diagnosis: 56
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