Kyle Robert A, Yee Gary C, Somerfield Mark R, Flynn Patrick J, Halabi Susan, Jagannath Sundar, Orlowski Robert Z, Roodman David G, Twilde Patricia, Anderson Kenneth
Dana-Farber Cancer Institute, Boston, MA, USA.
J Clin Oncol. 2007 Jun 10;25(17):2464-72. doi: 10.1200/JCO.2007.12.1269. Epub 2007 May 21.
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).
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.
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.
更新双膦酸盐类药物在多发性骨髓瘤骨病防治中应用的推荐意见。更新委员会将指南范围扩大至纳入颌骨坏死（ONJ）的讨论。
对于2007年更新版，由全体专家小组的成员组成的更新委员会对2002年以来发表的数据进行了回顾和分析。检索了Medline和Cochrane协作图书馆数据库。
对于在X线平片或影像学检查中存在骨质溶解性破坏或因骨质减少导致脊柱压缩性骨折的多发性骨髓瘤患者，推荐每3至4周静脉输注帕米膦酸90 mg，输注时间至少2小时，或唑来膦酸4 mg，输注时间至少15分钟。氯膦酸盐是一种在全球（美国除外）获批用于口服或静脉给药的双膦酸盐类替代药物。唑来膦酸的药品说明书中增加了针对已有肾功能损害患者的新给药指南。虽然尚无帕米膦酸的类似给药指南，但更新委员会建议临床医生考虑降低已有肾功能损害患者的帕米膦酸初始剂量。唑来膦酸尚未在严重肾功能损害患者中进行研究，因此不建议在此类患者中使用。更新委员会建议双膦酸盐治疗持续2年。2年后，对于病情缓解或稳定的患者，医生应认真考虑停用双膦酸盐类药物，但后续使用由治疗医生自行决定。更新委员会还讨论了关于颌骨坏死的应对措施。
