title: Zoledronic acid for prevention of bone loss in patients receiving primary therapy for lymphomas: a prospective, randomized controlled phase III trial.
abstract: In patients with newly diagnosed lymphoma, low bone mineral density (BMD) is common at diagnosis and worsens with therapy. Our randomized phase III trial demonstrates that 2 doses of zoledronic acid (ZA) and supplementation with calcium and vitamin D effectively prevent further bone loss.
  
  
  BACKGROUND
  Patients with lymphoma are at risk of development of bone mineral density (BMD) loss from therapy with high-dose corticosteroids and alkylating agents. Zoledronic acid (ZA), a bisphosphonate, may prevent this complication of therapy. We evaluated the effect of ZA on the change in BMD and surrogate biomarkers in patients with lymphoma receiving initial chemotherapy.
  
  
  METHODS
  Our phase III trial randomized 74 patients with newly diagnosed lymphoma and a baseline BMD of ≥ -2.0 to receive oral calcium and vitamin D daily with or without ZA at enrollment and at 6 months after enrollment. BMD was evaluated at baseline and 1 year after enrollment. Secondary biomarker endpoints were collected at baseline and at 3, 6, 9, and 12 months after enrollment.
  
  
  RESULTS
  Forty-three percent of patients had baseline osteopenia. Fifty-three patients were evaluable for response: 24 received ZA and had stable BMD during the observation period, whereas 29 patients in the control group had decreased BMD (P < .05 at lumbar spine and bilateral femoral neck). Twenty-one randomized patients were not evaluable for response because of lymphoma progression or death, withdrawn consent/incomplete testing, or ineligibility. Bone biomarkers were higher in the control group at all intervals after treatment (P < .001). No fractures or intervention-related toxicities were observed during this trial.
  
  
  CONCLUSIONS
  Newly diagnosed patients with lymphoma are at risk of low BMD, which may worsen with therapy. Treatment with ZA effectively stabilizes BMD and prevents bone loss. Our data suggest that BMD testing and prophylaxis should be considered as an early intervention for a preventable problem.
authors.affiliation: Department of Lymphoma and Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Jason R
authors.initials: JR
authors.lastname: Westin
authors.forename: Michael A
authors.initials: MA
authors.lastname: Thompson
authors.forename: Vince D
authors.initials: VD
authors.lastname: Cataldo
authors.forename: Luis E
authors.initials: LE
authors.lastname: Fayad
authors.forename: Nathan
authors.initials: N
authors.lastname: Fowler
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Fanale
authors.forename: Saatva
authors.initials: S
authors.lastname: Neelapu
authors.forename: Felipe
authors.initials: F
authors.lastname: Samaniego
authors.forename: Jorge
authors.initials: J
authors.lastname: Romaguera
authors.forename: Jatin
authors.initials: J
authors.lastname: Shah
authors.forename: Peter
authors.initials: P
authors.lastname: McLaughlin
authors.forename: Barbara
authors.initials: B
authors.lastname: Pro
authors.forename: Larry W
authors.initials: LW
authors.lastname: Kwak
authors.forename: Perpetua
authors.initials: P
authors.lastname: Sanjorjo
authors.forename: William A
authors.initials: WA
authors.lastname: Murphy
authors.forename: Camillo
authors.initials: C
authors.lastname: Jimenez
authors.forename: Bela
authors.initials: B
authors.lastname: Toth
authors.forename: Wenli
authors.initials: W
authors.lastname: Dong
authors.forename: Fredrick B
authors.initials: FB
authors.lastname: Hagemeister
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D015519:Bone Density / Q000187:drug effects; D050071:Bone Density Conservation Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001862:Bone Resorption / Q000209:etiology* / Q000517:prevention & control*; D004164:Diphosphonates / Q000494:pharmacology / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007093:Imidazoles / Q000494:pharmacology / Q000627:therapeutic use*; D008223:Lymphoma / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016896:Treatment Outcome; D055815:Young Adult; D000077211:Zoledronic Acid
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D000077211:Zoledronic Acid