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Zoledronic acid remains preferred treatment for newly diagnosed multiple myeloma
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Zoledronic acid should remain the preferred treatment for patients with newly diagnosed multiple myeloma who undergo autologous stem cell transplantation, results of a retrospective study suggest.
Zoledronic acid was associated with a lower rate of surgical-related events and longer OS than clodronic acid among patients who did not achieve complete response after autologous stem cell transplantation (ASCT), the results showed. The benefits of zoledronic acid were consistent regardless of patients’ bone disease status, researchers wrote.
Previous findings from the MRC Myeloma IX randomized trial indicated zoledronic acid significantly reduced skeletal-related events and improved PFS and OS compared with clodronic acid — an oral first-generation bisphosphonate — in patients with newly diagnosed multiple myeloma.
“[However], there remains considerable interest in how the achievement of deep responses impact on bone disease and the necessity for ongoing bisphosphonate treatment,” the researchers wrote. “Current guidelines lack evidence to support firm decisions with regard to the optimal duration of bisphosphonates and the frequency of its dosing for patients in complete response following effective induction treatments.”
In the current study, researchers reviewed the trial data with a focus on 749 patients of the intensive pathway who were eligible for autologous stem cell transplantation.
Seventy-three percent of patients had bone disease at baseline. Median follow-up was 5.71 years for the zoledronic acid group and 5.54 years for the clodronic acid group.
The overall complete response rate improved from 13% to 48% after ASCT. This translated into extended PFS and OS. Researchers observed complete response — defined as negative immunofixation of serum and urine, as well as less than 5% plasma cells in bone marrow — in 48% of patients. They reported partial responses in 23% of patients.
Overall, 31.5% of patients had a skeletal-related event that occurred before or as the first event of progression.
Zoledronic acid was associated with a significant reduction in skeletal-related events compared with clodronic acid (155 vs. 202), researchers wrote.
Patients with bone disease at baseline had significantly shorter OS than patients without bone disease (median 63.7 vs. 70.9 months; P=.047). When the researchers further examined the impact of bisphosphonate type, zoledronic acid was associated with a significantly increased survival in patients with bone disease at baseline (median 69.8 vs. 58.8 months; P=.047).
“These findings indicate that response category post-transplant may influence the impact of bisphosphonate therapy,” the researchers wrote.
Disclosure: The researchers report research support and honoraria from, as well as consultant, advisory and speakers’ roles with, Amgen, Bristol-Myers Squibb, Celgene, Chugai, Janssen-Cilag, Millennium, Novartis and Onyx.
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