THE REAL WORLD USE OF BISPHOSPHONATES IN MULTIPLE MYELOMA AT UNIVERSITY COLLEGE HOSPITAL (UCH), LONDON: A COMPARISON WITH LATEST GUIDANCE
(Abstract release date: 05/19/16)
EHA Library. Cohen O. 06/09/16; 134784; PB1884
Dr. Oliver Cohen
Contributions
Contributions
Abstract
Abstract: PB1884
Type: Publication Only
Background
The use of intravenous bisphosphonates in patients diagnosed with myeloma is regarded as standard of care, irrespective of the presence of bone lesions. The only exceptions may be patients in advanced renal failure, or those with osteonecrosis of the jaw (ONJ). Zoledronic acid is the bisphosphonate of choice given evidence of an anti-myeloma effect, including survival. Optimal duration of bisphosphonate usage is less clear but the recommendation from the International Myeloma Working Group (IMWG) is to continue for a minimum of 1-2 years after which discontinuation can be considered if complete response (CR) or very good partial response (VGPR) is achieved. This guidance is recommended but not always followed. We review clinical practice surrounding bisphosphonate usage at a tertiary centre.
Aims
To describe the real world use of bisphosphonates in patients attending a specialist myeloma clinic and how it compares with published guidance.
Methods
A sample of 60 patients with symptomatic myeloma was taken sequentially from clinic lists in December 2015. Data was collected for these patients from clinical case record (CDR) and electronic prescribing system (Chemocare) in regards to current disease status, chemotherapy, bisphosphonate use and complications and renal function. A literature search was performed using Pubmed in order to collate the latest guidance.
Results
60 patients with myeloma attending the myeloma clinic were identified. Of these, 55% were male. 10% patients were <50 years old, 72% patients were aged 50-70 and 18% were >70 years old. 27% were diagnosed with myeloma within the last 2 years. Disease isotypes were: 52% IgG, 12% IgA, 17% kappa light chain, 13% lambda light chain and 6% other disease type. 52% were on active treatment; 17% on Bortezomib regimens, 25% on Lenalidomide, 8% on Pomalidomide and 2% on other regimens. 58% of patients had abnormal renal function (GFR<90ml/min).57/60 were commenced on a bisphosphonate at diagnosis, which was Zoledronic acid in 77% of all cases but just 46% in patients with eGFR <60ml/min. In all other cases, it was Pamidronate. All patients had renal function monitored via a blood test prior to each bisphosphonate infusion but urine albumin was not measured. DEXA scans were not routinely done to assess bone density. 88% of patients diagnosed within 2 years were still on 4-weekly bisphosphonates. After 2 years, 12% had the bisphosphonate stopped whilst 48% had the frequency reduced to 2-3 monthly. The remaining 40% remained on monthly treatment. Of the 40% on monthly bisphosphonate treatment more than 2 years from diagnosis, most (88%) were being actively treated for their myeloma. Of the 31 patients on active treatment, 71% were still on 4 weekly bisphosphonates. Of patients with an eGFR of <60ml/minute, 64% had their bisphosphonate dose reduced. One patient had a reduction in treatment frequency as a consequence of ONJ. A further 4 patients had dental intervention documented during bisphosphonate treatment, one of whom had their bisphosphonate treatment held for 2 months as a result.
Conclusion
Compliance with IMWG guidance on initiation of bisphosphonates occurred in 95% of cases. Zoledronic acid is used less frequently in patients with abnormal renal function. Whilst frequency of bisphosphonate use often reduces after 2 years (61%), there is marked variability in the time point and disease status at which this occurs. Further work is required to clarify optimal duration of bisphosphonate use and scheduling, and the adjustments for osteonecrosis and dental intervention.
Session topic: E-poster
Keyword(s): Bisphosphonate, Myeloma, Supportive care
Type: Publication Only
Background
The use of intravenous bisphosphonates in patients diagnosed with myeloma is regarded as standard of care, irrespective of the presence of bone lesions. The only exceptions may be patients in advanced renal failure, or those with osteonecrosis of the jaw (ONJ). Zoledronic acid is the bisphosphonate of choice given evidence of an anti-myeloma effect, including survival. Optimal duration of bisphosphonate usage is less clear but the recommendation from the International Myeloma Working Group (IMWG) is to continue for a minimum of 1-2 years after which discontinuation can be considered if complete response (CR) or very good partial response (VGPR) is achieved. This guidance is recommended but not always followed. We review clinical practice surrounding bisphosphonate usage at a tertiary centre.
Aims
To describe the real world use of bisphosphonates in patients attending a specialist myeloma clinic and how it compares with published guidance.
Methods
A sample of 60 patients with symptomatic myeloma was taken sequentially from clinic lists in December 2015. Data was collected for these patients from clinical case record (CDR) and electronic prescribing system (Chemocare) in regards to current disease status, chemotherapy, bisphosphonate use and complications and renal function. A literature search was performed using Pubmed in order to collate the latest guidance.
Results
60 patients with myeloma attending the myeloma clinic were identified. Of these, 55% were male. 10% patients were <50 years old, 72% patients were aged 50-70 and 18% were >70 years old. 27% were diagnosed with myeloma within the last 2 years. Disease isotypes were: 52% IgG, 12% IgA, 17% kappa light chain, 13% lambda light chain and 6% other disease type. 52% were on active treatment; 17% on Bortezomib regimens, 25% on Lenalidomide, 8% on Pomalidomide and 2% on other regimens. 58% of patients had abnormal renal function (GFR<90ml/min).57/60 were commenced on a bisphosphonate at diagnosis, which was Zoledronic acid in 77% of all cases but just 46% in patients with eGFR <60ml/min. In all other cases, it was Pamidronate. All patients had renal function monitored via a blood test prior to each bisphosphonate infusion but urine albumin was not measured. DEXA scans were not routinely done to assess bone density. 88% of patients diagnosed within 2 years were still on 4-weekly bisphosphonates. After 2 years, 12% had the bisphosphonate stopped whilst 48% had the frequency reduced to 2-3 monthly. The remaining 40% remained on monthly treatment. Of the 40% on monthly bisphosphonate treatment more than 2 years from diagnosis, most (88%) were being actively treated for their myeloma. Of the 31 patients on active treatment, 71% were still on 4 weekly bisphosphonates. Of patients with an eGFR of <60ml/minute, 64% had their bisphosphonate dose reduced. One patient had a reduction in treatment frequency as a consequence of ONJ. A further 4 patients had dental intervention documented during bisphosphonate treatment, one of whom had their bisphosphonate treatment held for 2 months as a result.
Conclusion
Compliance with IMWG guidance on initiation of bisphosphonates occurred in 95% of cases. Zoledronic acid is used less frequently in patients with abnormal renal function. Whilst frequency of bisphosphonate use often reduces after 2 years (61%), there is marked variability in the time point and disease status at which this occurs. Further work is required to clarify optimal duration of bisphosphonate use and scheduling, and the adjustments for osteonecrosis and dental intervention.
Session topic: E-poster
Keyword(s): Bisphosphonate, Myeloma, Supportive care
Abstract: PB1884
Type: Publication Only
Background
The use of intravenous bisphosphonates in patients diagnosed with myeloma is regarded as standard of care, irrespective of the presence of bone lesions. The only exceptions may be patients in advanced renal failure, or those with osteonecrosis of the jaw (ONJ). Zoledronic acid is the bisphosphonate of choice given evidence of an anti-myeloma effect, including survival. Optimal duration of bisphosphonate usage is less clear but the recommendation from the International Myeloma Working Group (IMWG) is to continue for a minimum of 1-2 years after which discontinuation can be considered if complete response (CR) or very good partial response (VGPR) is achieved. This guidance is recommended but not always followed. We review clinical practice surrounding bisphosphonate usage at a tertiary centre.
Aims
To describe the real world use of bisphosphonates in patients attending a specialist myeloma clinic and how it compares with published guidance.
Methods
A sample of 60 patients with symptomatic myeloma was taken sequentially from clinic lists in December 2015. Data was collected for these patients from clinical case record (CDR) and electronic prescribing system (Chemocare) in regards to current disease status, chemotherapy, bisphosphonate use and complications and renal function. A literature search was performed using Pubmed in order to collate the latest guidance.
Results
60 patients with myeloma attending the myeloma clinic were identified. Of these, 55% were male. 10% patients were <50 years old, 72% patients were aged 50-70 and 18% were >70 years old. 27% were diagnosed with myeloma within the last 2 years. Disease isotypes were: 52% IgG, 12% IgA, 17% kappa light chain, 13% lambda light chain and 6% other disease type. 52% were on active treatment; 17% on Bortezomib regimens, 25% on Lenalidomide, 8% on Pomalidomide and 2% on other regimens. 58% of patients had abnormal renal function (GFR<90ml/min).57/60 were commenced on a bisphosphonate at diagnosis, which was Zoledronic acid in 77% of all cases but just 46% in patients with eGFR <60ml/min. In all other cases, it was Pamidronate. All patients had renal function monitored via a blood test prior to each bisphosphonate infusion but urine albumin was not measured. DEXA scans were not routinely done to assess bone density. 88% of patients diagnosed within 2 years were still on 4-weekly bisphosphonates. After 2 years, 12% had the bisphosphonate stopped whilst 48% had the frequency reduced to 2-3 monthly. The remaining 40% remained on monthly treatment. Of the 40% on monthly bisphosphonate treatment more than 2 years from diagnosis, most (88%) were being actively treated for their myeloma. Of the 31 patients on active treatment, 71% were still on 4 weekly bisphosphonates. Of patients with an eGFR of <60ml/minute, 64% had their bisphosphonate dose reduced. One patient had a reduction in treatment frequency as a consequence of ONJ. A further 4 patients had dental intervention documented during bisphosphonate treatment, one of whom had their bisphosphonate treatment held for 2 months as a result.
Conclusion
Compliance with IMWG guidance on initiation of bisphosphonates occurred in 95% of cases. Zoledronic acid is used less frequently in patients with abnormal renal function. Whilst frequency of bisphosphonate use often reduces after 2 years (61%), there is marked variability in the time point and disease status at which this occurs. Further work is required to clarify optimal duration of bisphosphonate use and scheduling, and the adjustments for osteonecrosis and dental intervention.
Session topic: E-poster
Keyword(s): Bisphosphonate, Myeloma, Supportive care
Type: Publication Only
Background
The use of intravenous bisphosphonates in patients diagnosed with myeloma is regarded as standard of care, irrespective of the presence of bone lesions. The only exceptions may be patients in advanced renal failure, or those with osteonecrosis of the jaw (ONJ). Zoledronic acid is the bisphosphonate of choice given evidence of an anti-myeloma effect, including survival. Optimal duration of bisphosphonate usage is less clear but the recommendation from the International Myeloma Working Group (IMWG) is to continue for a minimum of 1-2 years after which discontinuation can be considered if complete response (CR) or very good partial response (VGPR) is achieved. This guidance is recommended but not always followed. We review clinical practice surrounding bisphosphonate usage at a tertiary centre.
Aims
To describe the real world use of bisphosphonates in patients attending a specialist myeloma clinic and how it compares with published guidance.
Methods
A sample of 60 patients with symptomatic myeloma was taken sequentially from clinic lists in December 2015. Data was collected for these patients from clinical case record (CDR) and electronic prescribing system (Chemocare) in regards to current disease status, chemotherapy, bisphosphonate use and complications and renal function. A literature search was performed using Pubmed in order to collate the latest guidance.
Results
60 patients with myeloma attending the myeloma clinic were identified. Of these, 55% were male. 10% patients were <50 years old, 72% patients were aged 50-70 and 18% were >70 years old. 27% were diagnosed with myeloma within the last 2 years. Disease isotypes were: 52% IgG, 12% IgA, 17% kappa light chain, 13% lambda light chain and 6% other disease type. 52% were on active treatment; 17% on Bortezomib regimens, 25% on Lenalidomide, 8% on Pomalidomide and 2% on other regimens. 58% of patients had abnormal renal function (GFR<90ml/min).57/60 were commenced on a bisphosphonate at diagnosis, which was Zoledronic acid in 77% of all cases but just 46% in patients with eGFR <60ml/min. In all other cases, it was Pamidronate. All patients had renal function monitored via a blood test prior to each bisphosphonate infusion but urine albumin was not measured. DEXA scans were not routinely done to assess bone density. 88% of patients diagnosed within 2 years were still on 4-weekly bisphosphonates. After 2 years, 12% had the bisphosphonate stopped whilst 48% had the frequency reduced to 2-3 monthly. The remaining 40% remained on monthly treatment. Of the 40% on monthly bisphosphonate treatment more than 2 years from diagnosis, most (88%) were being actively treated for their myeloma. Of the 31 patients on active treatment, 71% were still on 4 weekly bisphosphonates. Of patients with an eGFR of <60ml/minute, 64% had their bisphosphonate dose reduced. One patient had a reduction in treatment frequency as a consequence of ONJ. A further 4 patients had dental intervention documented during bisphosphonate treatment, one of whom had their bisphosphonate treatment held for 2 months as a result.
Conclusion
Compliance with IMWG guidance on initiation of bisphosphonates occurred in 95% of cases. Zoledronic acid is used less frequently in patients with abnormal renal function. Whilst frequency of bisphosphonate use often reduces after 2 years (61%), there is marked variability in the time point and disease status at which this occurs. Further work is required to clarify optimal duration of bisphosphonate use and scheduling, and the adjustments for osteonecrosis and dental intervention.
Session topic: E-poster
Keyword(s): Bisphosphonate, Myeloma, Supportive care
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