title: What is the evidence for the use of bisphosphonate therapy in newly diagnosed multiple myeloma patients lacking bone disease?
abstract: A 55-year-old man without prior medical problems presented to the emergency room with a 2-month history of progressive fatigue. Initial workup showed a hemoglobin level of 9.0 g/dL and an increased total protein level of 12.6 g/dL. Further testing revealed a normal serum calcium and creatinine, an IgG kappa paraprotein of 5.4 g/dL, and a Bence Jones proteinuria of 450 mg of kappa light chain in 24 hours. The bone marrow showed 60% plasma cells with normal cytogenetics and t(4;14), but no other associated genetic abnormalities by FISH. Skeletal survey and MRI of the spine were negative for myeloma bone disease. The patient's oncologist recently began therapy with lenalidomide, bortezomib, and dexamethasone and recommended the initiation of zoledronic acid monthly. The patient questions the benefit of this drug because he has no bone disease.
authors.affiliation: Department of Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa, FL 33612, USA. frederick.locke@moffitt.org
authors.forename: Frederick L
authors.initials: FL
authors.lastname: Locke
authors.forename: Gareth J
authors.initials: GJ
authors.lastname: Morgan
mesh_terms: D001847:Bone Diseases / Q000150:complications / Q000517:prevention & control; D001897:Boronic Acids / Q000627:therapeutic use; D000069286:Bortezomib; D003907:Dexamethasone / Q000627:therapeutic use; D004164:Diphosphonates / Q000627:therapeutic use*; D005221:Fatigue; D050723:Fractures, Bone / Q000517:prevention & control; D006801:Humans; D007093:Imidazoles / Q000627:therapeutic use; D017404:In Situ Hybridization, Fluorescence; D000077269:Lenalidomide; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy* / Q000473:pathology*; D011507:Proteinuria / Q000175:diagnosis; D011719:Pyrazines / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D013792:Thalidomide / Q000031:analogs & derivatives / Q000627:therapeutic use; D013997:Time Factors; D014178:Translocation, Genetic; D016896:Treatment Outcome; D000077211:Zoledronic Acid
chemical_list: D001897:Boronic Acids; D004164:Diphosphonates; D007093:Imidazoles; D011719:Pyrazines; D013792:Thalidomide; D000069286:Bortezomib; D000077211:Zoledronic Acid; D003907:Dexamethasone; D000077269:Lenalidomide