Bone and kidneys are among the main affected organ systems in symptomatic multiple myeloma (MM) and may be associated with debilitating complications. Thus, bone health and renal protection are at the core of MM management. Bisphosphonates (BP) are recommended for prevention of bone complications in all newly diagnosed symptomatic MM patients, but BPs are also potentially nephrotoxic and are cleared by the kidneys. This study describes the routine clinical use of BP among MM patients in Denmark.
Adult patients newly diagnosed with MM between 01.01.2005 and 30.06.2015 were identified in the Danish National Multiple Myeloma Registry, and information on BP treatment in first-line (1L) anti-MM therapy was analyzed.
Among 2,633 MM patients with information on BP treatment in 1L, 1,838 (69.8%) received BP. Median time from MM diagnosis to BP treatment was 19 days (IQR: 9, 35). Receipt of BP among 1L-treated patients by therapy was: 79.4% (635/799) in autologous stem cell transplant recipients, 75.0% (793/1,058) in patients treated with conventional chemotherapy, and 70.2% (903/1,286) in those treated with bortezomib-, lenalidomide-, or thalidomide-containing regimens. Among the BP-treated patients, 67.2% (543/1,838) had no recorded hypercalcemia at MM diagnosis, 81.0% (1,489/1,838) had a record of skeletal-related events (SRE) in the 12 months before MM diagnosis, and 80.0% (1,470/1,838) had a record of osteolytic foci at 1L. An additional 431 patients had a record of osteolytic foci but no record of BP treatment. Patients without a record of BP treatment had higher prevalence of overall hospital-registered comorbidity, anemia, or higher ISS stage at MM diagnosis than patients with a record of BP treatment. Severe renal impairment (stages 4 - 5) was recorded at MM diagnosis in 31.8% of patients with no BP record and in 12.6% of patients with BP record at 1L start.
In newly diagnosed MM patients receiving 1L, co-administration of BP and anti-MM therapy is widespread, though less prevalent in patients with renal impairment or comorbidity burden.
Clinical trial identification
Legal entity responsible for the study
This study was funded by Amgen Inc. via institutional research grant to and administered by Aarhus University.
V. Ehrenstein, A.G. Ording, S.P. Ulrichsen: Employee of Aarhus University. I.T. Andersen, C. Helleberg, T. Silkjær, N. Abildgaard: Employee of the listed institution. A. Seesaghur, R. Hernandez, D. Niepel: Employee and stockholder: Amgen.