title: Bisphosphonate treatment and renal function in 201 myeloma patients undergoing stem cell transplantation.
abstract: Administration of bisphosphonates (BPs) is an essential supportive treatment for reducing bone-related complications in cancer. Deterioration of renal function is one possible side effect of BPs as well as a clinical feature in multiple myeloma. It has been suggested that the nephrotoxicity of different BPs may differ. We performed a retrospective evaluation of renal function in 201 myeloma patients undergoing myeloablative chemotherapy and treatment with ibandronate (I), pamidronate (P), or zoledronate (Z) for up to 36 months. There was no significant deterioration in mean creatinine clearance (CreaCl) in the entire cohort. The percentage of patients experiencing a decrease in CreaCl ≥ 25 % from baseline was 33.0 % in the I group, 44.4 % in the P group and 21.4 % in the Z group, respectively. CreaCl at baseline (P < 0.0001), relapse/progression (P = 0.0019), proteinuria at baseline (P = 0.039), age (P = 0.0031) were identified as significant independent predictors of decrease in renal function. In both descriptive multivariant analyses, we found no evidence of an advantage of any particular BP with respect to effects on renal function. In line with these data, in a subgroup of 90 patients with a baseline CreaCl <90 ml/min, no significant difference was evident between the cohorts of patients treated with different BPs. Regular treatment with the BPs I, P and Z in myeloma patients undergoing intensive chemotherapy appear to be equally safe for up to 3 years in terms of nephrotoxicity.
authors.affiliation: Department of Medicine V, University of Heidelberg, Heidelberg, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Schmitt
authors.forename: T
authors.initials: T
authors.lastname: Hielscher
authors.forename: C
authors.initials: C
authors.lastname: Baldus
authors.forename: K
authors.initials: K
authors.lastname: Neben
authors.forename: G
authors.initials: G
authors.lastname: Egerer
authors.forename: J
authors.initials: J
authors.lastname: Hillengaß
authors.forename: M
authors.initials: M
authors.lastname: Raab
authors.forename: D
authors.initials: D
authors.lastname: Hose
authors.forename: A D
authors.initials: AD
authors.lastname: Ho
authors.forename: R
authors.initials: R
authors.lastname: Bergner
authors.forename: H
authors.initials: H
authors.lastname: Goldschmidt
authors.forename: T M
authors.initials: TM
authors.lastname: Moehler
mesh_terms: D000328:Adult; D000368:Aged; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D003404:Creatinine / Q000097:blood / Q000652:urine; D004164:Diphosphonates / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D007677:Kidney Function Tests; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy* / Q000503:physiopathology* / Q000628:therapy; D012074:Remission Induction; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D003404:Creatinine