According to a recent study, the bisphosphonate Aredia reduces skeletal-related events, such as bone lesions and bone fractures, in patients with smoldering multiple myeloma; however, it does not prevent disease progression to symptomatic myeloma.

According to the study authors, these findings are consistent with the findings of previous studies that had shorter follow-up times.

Bone disease is frequently associated with multiple myeloma and can cause bone pain and fractures (see related Beacon news). While the symptoms of bone disease can be treated with radiation therapy and surgical procedures, bisphosphonates are currently the only available treatment that can prevent bone disease.

Aredia (pamidronate) is a bisphosphonate commonly used to prevent bone disease in multiple myeloma patients. It is administered intravenously once a month.

Although bisphosphonates do not treat the underlying causes of multiple myeloma, recent studies have demonstrated that bisphosphonate treatment may provide a survival advantage in myeloma patients (see related Beacon news).

The goal of this study was to determine if bisphosphonate treatment, specifically treatment with Aredia, would affect the progression of smoldering myeloma to symptomatic myeloma. 

The study included 177 smoldering multiple myeloma patients, 89 of whom received 90 mg of Aredia once a month for one year. Aredia was administered as an intravenous infusion in an outpatient setting. The remaining 88 patients did not receive Aredia treatment and were observed. The researchers followed and evaluated all patients for five years.

The researchers found that 62.9 percent of patients who received Aredia treatment progressed to symptomatic myeloma, compared to 62.5 percent of patients who did not receive Aredia treatment. The median progression-free survival was 46 months for Aredia-treated patients and 48 months for untreated patients. 

Although Aredia treatment did not improve progression to symptomatic myeloma, it did significantly reduce skeletal-related events that occurred at the time of disease progression. Skeletal-related events were defined as bone lesions, bone fractures, and/or high calcium levels in the blood.

In the Aredia group, 39.2 percent experienced skeletal-related events at the time of disease progression, compared to 72.2 percent of untreated patients. 

The researcher pointed out that Aredia caused few side effects. Three patients interrupted treatment due to fever or severe low blood pressure.

In particular, the researchers did not observe any cases of low calcium levels or osteonecrosis of the jaw, a condition that is associated with a loss of blood supply to the jaw resulting in jawbone death. 

For more information, see the research article in Leukemia & Lymphoma (abstract).okay