[Multibilly]

When to start bisphosphonates?

by Multibilly on Fri Apr 12, 2013 3:40 pm

Hey there esteemed multiple myeloma followers,

I just got my latest lab results back today and an annoying breeze appears to be gently fanning my smoldering plasma cells. My M-Spike went from 1.74 to 2.15 in a couple of months (started at 1.67 in 11/2012). My IgG went from 2890 to 3195 and my albumin is also slowly and steadily increasing and now stands at 4.2 (still in normal range, but increases with every test). And for the first time, I went slightly high on calcium, moving from 9.9 to 10.3 (upper limit of normal is 10.1). The good news is that no lytic lesions or even hints of "suspicious translucencies" showed up on my xrays. My bone plasma cell concentration from my BMB back in 11/2012 was 11% and my cytogenetics were good at that time.

Nothing dramatic, but the trends in the wrong directions are clearly there (damn it) as I graph the results of my four lab tests since I first got diagnosed back in Nov 2012.

My doc said that at this rate, his hunch is that I will likely being looking at some sort of treatment in 1-2 years, which is believable as I graph the data. We ended the day by him saying let's just wait and see what the next round of tests bring in a couple of months, which seems prudent.

But we did briefly discuss first starting with a bisphosphonate if my calcium level continues to climb. My question is just when would you pull the trigger on starting something like Zometa under my circumstances?

Last edited by Multibilly on Fri Apr 12, 2013 6:55 pm, edited 2 times in total.

[blizard49]

Re: When to start bisphosphonates?

by blizard49 on Fri Apr 12, 2013 4:33 pm

MB- I started Zometa with induction right after diagnosis, but I had a few lesions. It works well for me, and other than some bone pain after the first infusion, it has been problem-free, and I've had no new bone issues. Still on it after a year. Be sure they administer it over 45 minutes, not faster, and hydrate really well for 72 hours afterward. It can generate calcium that needs to get flushed out.
Good luck
Eric

[Dr. Peter Voorhees]

Re: When to start bisphosphonates?

by Dr. Peter Voorhees on Sun Apr 14, 2013 8:52 am

Zometa was tested in a small randomized study of smoldering (asymptomatic) myeloma patients. Patients were randomized to observation alone vs. monthly zometa for 1 year. There was no difference between the 2 groups as far as the time to developing symptomatic myeloma. However, fewer patients who received zometa had skeletal-related events at the time of progression to symptomatic disease (55.5% of patients on zometa had skeletal-related events vs. 78.3% of those who were simply observed). As with everything in myeloma, there is no free lunch. You have to weigh the risks and benefits of any intervention.

Best of luck and let us know what you decide to do!

Pete V.