IMWG Guidelines for the Use of Bisphosphonates in Myeloma

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Intravenous bisphosphonate therapy has been amply demonstrated to reduce bone complications of myeloma.   Bisphosphonate (BP) therapy is therefore an important component of supportive care for myeloma patients with boney disease. Adverse events associated with BP are usually mild and consist of fever, renal function impairment, myalgias, and hypocalcemia.  A more serious potential side effect of bisphosphonate therapy that was first identified in 20031 is osteonecrosis of the jaw (ONJ), a debilitating problem that can be associated with significant morbidity. The following guidelines for the use of bisphosphonate therapy in myeloma are based upon IMWG and Mayo Clinic guidelines2,3 and are intended to provide safe criteria for bisphosphonate use to minimize […]

The role of vertebral augmentation in multiple myeloma: International Myeloma Working Group Consensus Statement

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There are approximately 20 000 new patients diagnosed with myeloma in the United States each year.1 With the availability of better treatments and resultant improved survival, there are currently close to 100 000 patients living with myeloma in the United States. Similar incidence and prevalence rates exist throughout Europe.2 Of these patients, the spine is affected by osteolytic and/or osteopenic bone disease in 70%.3 Myeloma is the commonest primary cancer affecting the spine. Painful vertebral compression fractures (VCFs) affect approximately 30% of myeloma patients. As myeloma patients live longer, it is especially relevant to provide the best available treatment for pain and reduce disabilities that can result from VCFs.4 The focus of […]

Prevention of thalidomide- and lenalidomide-associated thrombosis in myeloma

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The incidence of venous thromboembolism (VTE) is more than 1 per thousand annually in the general population and increases further in cancer patients. The risk of VTE is higher in multiple myeloma (MM) patients who receive thalidomide or lenalidomide, especially in combination with dexamethasone or chemotherapy. Various VTE prophylaxis strategies, such as low-molecular-weight heparin (LMWH), warfarin or aspirin, have been investigated in small, uncontrolled clinical studies. This manuscript summarizes the available evidence and recommends a prophylaxis strategy according to a risk-assessment model. Individual risk factors for thrombosis associated with thalidomide/lenalidomide-based therapy include age, history of VTE, central venous catheter, comorbidities (infections, diabetes, cardiac disease), immobilization, surgery and inherited thrombophilia. Myeloma-related […]

Use of bisphosphonates in multiple myeloma: IMWG response to Mayo Clinic consensus statement.

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The International Myeloma Working Group (IMWG), which comprises 85 investigators  specializing in the area of multiple myeloma, has reviewed and considered the recent Mayo Clinic consensus statement for the use of bisphosphonates (BPs) in multiple myeloma. Although the IMWG is in general agreement with the Mayo consensus statement, several important issues have been raised and are discussed subsequently. These comments are in response to the recommendations of  the Mayo group, which is normally part of the IMWG. Author: Durie BG Mayo Clin Proc. 2007 Apr;82(4):516-7; author reply 517-8. Click here to view Article