Abstract 5821
Background
Bone involvement is a defining feature of symptomatic multiple myeloma (MM). There is little information on changes in bone mineral metabolism that occur with bisphosphonates and anti-myeloma medication.
Methods
Newly-diagnosed MM patients were prospectively enrolled from January to December 2017. Serum bone turnover markers estimation [CTX, P1NP, and Osteocalcin (OC)], DEXA scan, and Tc99 bone scintigraphy were assessed at baseline. Antimyeloma drugs and monthly bisphosphonates were given as per institutional protocol. Bone turnover markers were re-assessed at 3 months.
Results
24 patients were enrolled. Median age was 55 years (35 – 76 years); 79.16% males. Bone pains and anemia were most common [renal failure 45.8% and hypercalcemia 45.8%]. IgG subtype was most common (52%) [IgA 21%, light chain 16%]. 83.3% had ISS stage III disease; mean β-2 microglobulin was 17.81 (± 25.16) mg/mL. 70.83% patients had multiple lytic lesions and 29.16% had baseline fracture. On DEXA scan, 41.67% had osteopenia and 12.5% had osteoporosis. All bone markers showed a graded but statistically insignificant correlation with the extent of bone involvement, P > 0.05. Baseline CTX levels in patients with pathological fractures were significantly higher. Baseline β-2 microglobulin significantly correlated with CTX (r = 0.44) and P1NP (r = 0.43) levels; OC showed no such correlation. At 3 months, a significant decline was seen in CTX levels [0.46 (±0.84) v 1.16 (±1.19), P = 0.001]; minimal rise was seen in P1NP and OC levels, P > 0.05. Fall in CTX levels in patients receiving VTD regimen was significantly greater than VCD regimen, P = 0.012. The decline in CTX among patients exclusively treated with zoledronate was significantly larger than those who received initial ibandronate followed by zoledronate, P = 0.017. At 3 months, overall response rate was 75% [CR 16.7%, VGPR 50%, PR 33.3%].
Conclusions
The bone turnover markers significantly correlated with β-2 microglobulin. Bisphosphonates and anti-myeloma medications considerably reduced CTX (bone resorption marker) but had a trivial effect on P1NP and OC. Larger prospective studies with longer follow up are required to interpret dynamics of bone turnover markers in myeloma.
Clinical trial identification
Legal entity responsible for the study
PGIMER, Chandigarh.
Funding
Has not received any funding.
Editorial Acknowledgement
Disclosure
All authors have declared no conflicts of interest.
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