OSTEONECROSIS OF THE JAW IN PATIENTS WITH MULTIPLE MYELOMA IN THE ERA OF MORE POTENT BISPHOSPHANATES
(Abstract release date: 05/19/16)
EHA Library. Pavkovic M. 06/09/16; 134867; PB1967
Dr. Marica Pavkovic
Contributions
Contributions
Abstract
Abstract: PB1967
Type: Publication Only
Background
Long term use of bisphosphonates has been associated with increased incidence of osteonecrosis of the jaw (ONJ). ONJ is commonly precipitated by a tooth extraction or other stomatological procedure in patients treated with long term, potent, high dose intravenous bisphosphonates for the management of myeloma, breast or prostate cancer. ONJ is most commonly reported in patients with MM, but it can occur in all cancer patients treated with bisphosphonates for bone metastatic disease.
Aims
The aim of this study was to evaluate the incidence of ONJ in patients with myeloma treated with bisphosphonates during the last 11 years in our institution.
Methods
We have analyzed 422 patients diagnosed with multiple myeloma in our institution in the period of 2002-2013. Median age at diagnosis was 63 years (range: 36-91), median duration of myeloma was 3.9 years (3 months-14 years). Most common isotype of myeloma was IgG Isotype (62%) and almost 80% of patients had bone lesion at the time of diagnosis. Most common chemotherapy protocol was thalidomide based protocol with more than half of patients treated with thalidomide. Only 351/422 patients (83.2%) were treated with bisphosphonates.
Results
Incidence of ONJ in patients treated with bisphosphonates was 9/351 (2.6%). Median duration of bisphosphonates treatment was 28.5±19.4 months (range: 3-98 months). Most commonly used bisphosponate was i.v. pamidronate 175/351(49.8%), while 218/351 (62.1%) were treated with two or more types of bisphosphonates. Zolendronate was used in 79 patients (22.5%). 83 patients (23.6%) received oral forms of bisphosphonates; 56.2% patients were treated with i.v. forms of pamidronate, ibondronate, clodronate or zolendronate, and 85 patients (24.2%) received combination of oral and i.v. forms of bisphosphonates. Mean duration of bisphosphonates therapy was 33.8±21.7 months. When we compare the incidence of ONJ in the period before and after 2009 (year when we started to use zolendronic acid in the treatment of MM), we could notice a rise in the number of cases with ONJ. In the period 2002-2009 we have registered only 2/190 (1%) cases with ONJ comparing to 7/161(4,3%) patients with ONJ in the period 2009-2013. Despite the evident rise in the number of cases of ONJ in the era of more potent bisphsphonates, these difference was not significant (p=0.058).
Conclusion
The incidence of ONJ in our institution is similar to already referred incidence in other studies and it has become more common complication of bisphosphonate treatment since we have started to use more potent intravenous forms of bisphosphonates. High cumulative doses of bisphosphonates, type of used bisphosphonate, poor oral health, and dental extractions may be significant risk factors for ONJ development. Preventive measures like stomatological examination before bisphosphonates treatment and regular stomatological check-ups during bisphosphonates treatment must be considered.
Session topic: E-poster
Keyword(s): Bisphosphonate, Multiple myeloma, Osteonecrosis
Type: Publication Only
Background
Long term use of bisphosphonates has been associated with increased incidence of osteonecrosis of the jaw (ONJ). ONJ is commonly precipitated by a tooth extraction or other stomatological procedure in patients treated with long term, potent, high dose intravenous bisphosphonates for the management of myeloma, breast or prostate cancer. ONJ is most commonly reported in patients with MM, but it can occur in all cancer patients treated with bisphosphonates for bone metastatic disease.
Aims
The aim of this study was to evaluate the incidence of ONJ in patients with myeloma treated with bisphosphonates during the last 11 years in our institution.
Methods
We have analyzed 422 patients diagnosed with multiple myeloma in our institution in the period of 2002-2013. Median age at diagnosis was 63 years (range: 36-91), median duration of myeloma was 3.9 years (3 months-14 years). Most common isotype of myeloma was IgG Isotype (62%) and almost 80% of patients had bone lesion at the time of diagnosis. Most common chemotherapy protocol was thalidomide based protocol with more than half of patients treated with thalidomide. Only 351/422 patients (83.2%) were treated with bisphosphonates.
Results
Incidence of ONJ in patients treated with bisphosphonates was 9/351 (2.6%). Median duration of bisphosphonates treatment was 28.5±19.4 months (range: 3-98 months). Most commonly used bisphosponate was i.v. pamidronate 175/351(49.8%), while 218/351 (62.1%) were treated with two or more types of bisphosphonates. Zolendronate was used in 79 patients (22.5%). 83 patients (23.6%) received oral forms of bisphosphonates; 56.2% patients were treated with i.v. forms of pamidronate, ibondronate, clodronate or zolendronate, and 85 patients (24.2%) received combination of oral and i.v. forms of bisphosphonates. Mean duration of bisphosphonates therapy was 33.8±21.7 months. When we compare the incidence of ONJ in the period before and after 2009 (year when we started to use zolendronic acid in the treatment of MM), we could notice a rise in the number of cases with ONJ. In the period 2002-2009 we have registered only 2/190 (1%) cases with ONJ comparing to 7/161(4,3%) patients with ONJ in the period 2009-2013. Despite the evident rise in the number of cases of ONJ in the era of more potent bisphsphonates, these difference was not significant (p=0.058).
Conclusion
The incidence of ONJ in our institution is similar to already referred incidence in other studies and it has become more common complication of bisphosphonate treatment since we have started to use more potent intravenous forms of bisphosphonates. High cumulative doses of bisphosphonates, type of used bisphosphonate, poor oral health, and dental extractions may be significant risk factors for ONJ development. Preventive measures like stomatological examination before bisphosphonates treatment and regular stomatological check-ups during bisphosphonates treatment must be considered.
Session topic: E-poster
Keyword(s): Bisphosphonate, Multiple myeloma, Osteonecrosis
Abstract: PB1967
Type: Publication Only
Background
Long term use of bisphosphonates has been associated with increased incidence of osteonecrosis of the jaw (ONJ). ONJ is commonly precipitated by a tooth extraction or other stomatological procedure in patients treated with long term, potent, high dose intravenous bisphosphonates for the management of myeloma, breast or prostate cancer. ONJ is most commonly reported in patients with MM, but it can occur in all cancer patients treated with bisphosphonates for bone metastatic disease.
Aims
The aim of this study was to evaluate the incidence of ONJ in patients with myeloma treated with bisphosphonates during the last 11 years in our institution.
Methods
We have analyzed 422 patients diagnosed with multiple myeloma in our institution in the period of 2002-2013. Median age at diagnosis was 63 years (range: 36-91), median duration of myeloma was 3.9 years (3 months-14 years). Most common isotype of myeloma was IgG Isotype (62%) and almost 80% of patients had bone lesion at the time of diagnosis. Most common chemotherapy protocol was thalidomide based protocol with more than half of patients treated with thalidomide. Only 351/422 patients (83.2%) were treated with bisphosphonates.
Results
Incidence of ONJ in patients treated with bisphosphonates was 9/351 (2.6%). Median duration of bisphosphonates treatment was 28.5±19.4 months (range: 3-98 months). Most commonly used bisphosponate was i.v. pamidronate 175/351(49.8%), while 218/351 (62.1%) were treated with two or more types of bisphosphonates. Zolendronate was used in 79 patients (22.5%). 83 patients (23.6%) received oral forms of bisphosphonates; 56.2% patients were treated with i.v. forms of pamidronate, ibondronate, clodronate or zolendronate, and 85 patients (24.2%) received combination of oral and i.v. forms of bisphosphonates. Mean duration of bisphosphonates therapy was 33.8±21.7 months. When we compare the incidence of ONJ in the period before and after 2009 (year when we started to use zolendronic acid in the treatment of MM), we could notice a rise in the number of cases with ONJ. In the period 2002-2009 we have registered only 2/190 (1%) cases with ONJ comparing to 7/161(4,3%) patients with ONJ in the period 2009-2013. Despite the evident rise in the number of cases of ONJ in the era of more potent bisphsphonates, these difference was not significant (p=0.058).
Conclusion
The incidence of ONJ in our institution is similar to already referred incidence in other studies and it has become more common complication of bisphosphonate treatment since we have started to use more potent intravenous forms of bisphosphonates. High cumulative doses of bisphosphonates, type of used bisphosphonate, poor oral health, and dental extractions may be significant risk factors for ONJ development. Preventive measures like stomatological examination before bisphosphonates treatment and regular stomatological check-ups during bisphosphonates treatment must be considered.
Session topic: E-poster
Keyword(s): Bisphosphonate, Multiple myeloma, Osteonecrosis
Type: Publication Only
Background
Long term use of bisphosphonates has been associated with increased incidence of osteonecrosis of the jaw (ONJ). ONJ is commonly precipitated by a tooth extraction or other stomatological procedure in patients treated with long term, potent, high dose intravenous bisphosphonates for the management of myeloma, breast or prostate cancer. ONJ is most commonly reported in patients with MM, but it can occur in all cancer patients treated with bisphosphonates for bone metastatic disease.
Aims
The aim of this study was to evaluate the incidence of ONJ in patients with myeloma treated with bisphosphonates during the last 11 years in our institution.
Methods
We have analyzed 422 patients diagnosed with multiple myeloma in our institution in the period of 2002-2013. Median age at diagnosis was 63 years (range: 36-91), median duration of myeloma was 3.9 years (3 months-14 years). Most common isotype of myeloma was IgG Isotype (62%) and almost 80% of patients had bone lesion at the time of diagnosis. Most common chemotherapy protocol was thalidomide based protocol with more than half of patients treated with thalidomide. Only 351/422 patients (83.2%) were treated with bisphosphonates.
Results
Incidence of ONJ in patients treated with bisphosphonates was 9/351 (2.6%). Median duration of bisphosphonates treatment was 28.5±19.4 months (range: 3-98 months). Most commonly used bisphosponate was i.v. pamidronate 175/351(49.8%), while 218/351 (62.1%) were treated with two or more types of bisphosphonates. Zolendronate was used in 79 patients (22.5%). 83 patients (23.6%) received oral forms of bisphosphonates; 56.2% patients were treated with i.v. forms of pamidronate, ibondronate, clodronate or zolendronate, and 85 patients (24.2%) received combination of oral and i.v. forms of bisphosphonates. Mean duration of bisphosphonates therapy was 33.8±21.7 months. When we compare the incidence of ONJ in the period before and after 2009 (year when we started to use zolendronic acid in the treatment of MM), we could notice a rise in the number of cases with ONJ. In the period 2002-2009 we have registered only 2/190 (1%) cases with ONJ comparing to 7/161(4,3%) patients with ONJ in the period 2009-2013. Despite the evident rise in the number of cases of ONJ in the era of more potent bisphsphonates, these difference was not significant (p=0.058).
Conclusion
The incidence of ONJ in our institution is similar to already referred incidence in other studies and it has become more common complication of bisphosphonate treatment since we have started to use more potent intravenous forms of bisphosphonates. High cumulative doses of bisphosphonates, type of used bisphosphonate, poor oral health, and dental extractions may be significant risk factors for ONJ development. Preventive measures like stomatological examination before bisphosphonates treatment and regular stomatological check-ups during bisphosphonates treatment must be considered.
Session topic: E-poster
Keyword(s): Bisphosphonate, Multiple myeloma, Osteonecrosis
{{ help_message }}
{{filter}}