[Dr. Peter Voorhees]

Re: Zometa or Aredia for smoldering myeloma

by Dr. Peter Voorhees on Sun Oct 13, 2013 4:19 pm

Dear DanaH,

As the Beacon crew has pointed out, Zometa and Aredia have both been studied in smoldering multiple myeloma. They decrease the risk of skeletal related events (e.g. bone fractures) at the time of progression to symptomatic multiple myeloma, but they do not change the time to the development of symptomatic multiple myeloma.

I would consider it for those with low bone mineral density. For those with severely low bone mineral density, the physician has to consider the situation carefully and determine if the patient may in fact have symptomatic multiple myeloma rather than smoldering disease. This can be challenging, especially in older patients, post-menopausal women, heavy smokers and patients with other risk factors for osteoporosis.

For coachhoke, it sounds as though you have symptomatic myeloma that was treated into an excellent remission and now you are just on maintenance Revlimid. If that is the case, the current guidelines call for 2 years of monthly treatment. If the disease is under excellent control at the 2-year mark, Zometa or Aredia can be suspended.

It should be noted that in the large MRC study in which newly diagnosed multiple myeloma patients were assigned to treatment with clodronate (Bonefos, not sold in the U.S.) or Zometa, patients on Zometa had fewer fractures (even if they did not have detectable bone disease at diagnosis -- the caveat that patients on the study likely only had skeletal surveys and not PET-CT scans) and they lived longer (the median overall survival was 5.5 months longer for those who received Zometa compared to those who received clodronate). As such, 2 years would be reasonable.

Hopefully, newer studies will help provide additional guidance about how best to use these agents.

Pete V.

[coachhoke]

Re: Zometa or Aredia for smoldering myeloma

by coachhoke on Sun Oct 13, 2013 5:02 pm

Thank you Dr. I have been very lucky and am in partial remission 0.2 M-spike and nothing active on PET/CT scan and am taking maintenance Revlimid . I do have multiple spinal lytic lesions but totally asymptomatic. I took a bone density test, which wasn't specific to spine, which really wasn't helpful.

I understand the consensus, but feel like I'm an exception for Zometa and am having a difficult time accepting the need for it in my case. I have always had strong bones (big milk and ice cream person plus lots of vitamin D).

Thanks again,
coach hoke

[Dr. Peter Voorhees]

Re: Zometa or Aredia for smoldering myeloma

by Dr. Peter Voorhees on Sun Oct 13, 2013 5:15 pm

With a good response to treatment, your risk of a fracture is likely low, but you do have evidence of bone breakdown on imaging by virtue of the fact that you have lytic lesions on imaging -- they may not be causing pain, but they are there. Additionally, the survival advantage with the use of Zometa is compelling. As such, I would at least strongly consider it.

Thanks!

Pete V.

[DanaH]

Re: Zometa or Aredia for smoldering myeloma

by DanaH on Sun Oct 13, 2013 10:55 pm

Thank you so much Dr. Voohees, you response and explanation was very helpful !
Dana H.

[coachhoke]

Re: Zometa or Aredia for smoldering myeloma

by coachhoke on Mon Oct 14, 2013 10:03 am

Thanks Dr.Vorhees; I really appreciate your input.

[DanaH]

Re: Zometa or Aredia for smoldering myeloma

by DanaH on Sat Mar 15, 2014 2:04 pm

Was wondering if there are any smoldering myeloma patients currently using Zometa or Aredia and if your specialists are following the IMWG recommendations published last year.

Thanks to all who respond!

Dana H

[Blee]

Re: Zometa or Aredia for smoldering myeloma

by Blee on Sun Mar 16, 2014 2:41 am

I was advised to start monthly Aredia. However, the first infusion was intense with lots of side effects. So, 2nd month, I got Zometa. That too caused side effects (despite reduced dose and increased infusion time). Presently changed to every 3 month schedule, so in holding pattern right now.

[auburngrad82]

Re: Zometa or Aredia for smoldering myeloma

by auburngrad82 on Wed Mar 19, 2014 12:12 pm

I was diagnosed with smoldering myeloma in 2002. Over a period of ten years my M-Spike increased slowly but steadily until it reached a level, combined with slight anemia, where we decided to treat it.

I was on Revlimid and Dex for four months beginning September 2012, then underwent a stem cell transplant in August 2013. Because my M-Spike didn't drop as much as we had hoped for we did Revlimid, Velcade, and Dex for two months after the transplant. After the RVD treatment my M-Spike was at .26. I'm now in my second month on maintenance Revlimid.

I did not have bone involvement before or after my transplant.

Yesterday my oncologist suggested that we might want to start Zometa. My question is: How do I decide? I see very little information about Zometa that's newer than 2010 and I'd like to know before I start it that it's worth starting. Because it took so long to develop and because there was no bone involvement, is Zometa worth it?

[Multibilly]

Re: Zometa or Aredia for smoldering myeloma

by Multibilly on Wed Mar 19, 2014 12:58 pm

Did you read April's article? It gives one pause when considering Zometa.

https://myelomabeacon.org/headline/2014/03/18/letters-from-cancerland-by-the-skin-of-my-teeth/

[Nancy Shamanna]

Re: Zometa or Aredia for smoldering myeloma

by Nancy Shamanna on Wed Mar 19, 2014 3:07 pm

I have been following the comments surrounding April's column yesterday with interest also. My situation was very clear cut in that I needed the help of the infusions of bisphosphonates to help to heal my fractured vertebrae. I had check ups done on my teeth to make sure that I did not require any dental procedures, such as tooth extraction, during this time. Also I was vigilant about dental hygiene. Luckilly, I did not develop ONJ, but my oncologist pulled me off bisphosphonates when he did because he also worries about that.

I noticed that one difference between Zometa and Aredia is that Zometa is given over a 15-minute infusion, and in my case the Aredia was given over four hours. After a couple of years, that infusion time was lowered to 2 hours. Just cancer centre protocols at work here. The reason that the Aredia was given over such a long time period was to dilute it a lot, thus protecting kidney function. Especially with multiple myeloma patients, one has to protect our kidneys! I do not know why Zometa is given over a shorter time span. Does anyone know why?

Before I was diagnosed with multiple myeloma, I had been diagnosed with osteopenia and I was prescribed Fosamax, an oral bisphosphonate (alendronate). Many post menopausal women and other people with osteoporosis are put onto Fosamax. The same risk of ONJ is there, but my understanding is that Fosamax is a drug with a lesser potency than Zometa or Aredia. I was still taking Fosamax at the time of my fractures, and then was switched over to Aredia as it became apparent that my real problem was multiple myeloma, not osteopenia connected to being post menopausal.

I have a question then: Why would not smoldering myeloma patients be put on a milder bisphosphonate, such as Fosamax, to give them some protection for their bones? It is lesser in strength and also is taken in pill form once a week, which is convenient and less expensive to administer too.