American Society of Clinical Oncology 2007 clinical practice guideline update on the role of bisphosphonates in multiple myeloma
American Society of Clinical Oncology 2007 clinical practice guideline update on the role of bisphosphonates in multiple myeloma
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DOI：
10.1200/jco.2007.12.1269
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发表时间：
2007-06-10
影响因子：
45.3
通讯作者：
Anderson, Kenneth
中科院分区：
文献类型：
--
作者：
Kyle, Robert A.;Yee, Gary C.;Anderson, Kenneth
目的更新双膦酸盐在多发性骨髓瘤骨病预防和治疗中的使用建议。更新委员会扩大了指导方针，包括颌骨骨坏死（ONJ）的讨论。方法对于2007年的更新，更新委员会成员组成的全小组完成了审查和分析自2002年以来发表的数据。建议对于多发性骨髓瘤患者，如果X线平片或影像学检查显示骨质疏松导致骨质溶解性破坏或脊柱压缩性骨折，建议每3 - 4周静脉注射帕米膦酸二钠90 mg，至少2小时给药，或唑来膦酸4 mg，至少15分钟给药。氯膦酸盐是一种替代双膦酸盐，除美国外，在全球范围内批准用于口服或静脉给药。在唑来膦酸药品说明书中增加了针对既存肾损害患者的新给药指南。虽然没有类似的剂量指南可用于帕米膦酸二钠，更新委员会建议临床医生考虑减少预先存在肾损害的患者的初始帕米膦酸二钠剂量。唑来膦酸尚未在重度肾损害患者中进行过研究，因此不建议在这种情况下使用。更新委员会建议双膦酸盐治疗持续2年。在2年时，医生应该认真考虑对有反应或病情稳定的患者停用双膦酸盐，但进一步使用由治疗医生决定。更新委员会还讨论了有关ONJ的措施。
Purpose To update the recommendations for the use of bisphosphonates in the prevention and treatment of bone disease in multiple myeloma. The Update Committee expanded the guideline to include a discussion of osteonecrosis of the jaw (ONJ).Methods For the 2007 update, an Update Committee composed of members from the full panel completed a review and analysis of data published since 2002. Searches of Medline and the Cochrane Collaboration Library databases were performed.Recommendations For multiple myeloma patients who have, on plain radiograph(s) or imaging studies, lytic destruction of bone or spine compression fracture from osteopenia, intravenous pamidronate 90 mg delivered over at least 2 hours or zoledronic acid 4 mg delivered over at least 15 minutes every 3 to 4 weeks is recommended. Clodronate is an alternative bisphosphonate approved worldwide, except in the United States, for oral or intravenous administration. New dosing guidelines for patients with pre-existing renal impairment were added to the zoledronic acid package insert. Although no similar dosing guidelines are available for pamidronate, the Update Committee recommends that clinicians consider reducing the initial pamidronate dose in patients with pre-existing renal impairment. Zoledronic acid has not been studied in patients with severe renal impairment and is not recommended in this setting. The Update Committee suggests that bisphosphonate treatment continue for a period of 2 years. At 2 years, physicians should seriously consider discontinuing bisphosphonates in patients with responsive or stable disease, but further use is at the discretion of the treating physician. The Update Committee also discusses measures regarding ONJ.