[Guidelines for the use of bisphosphonates in multiple myeloma: Recommendations of the expert committee of the Spanish Myeloma Group from the PETHEMA group]

Collapsing glomerulopathy: update

Collapsing glomerulopathy (CG) is a rare entity as a glomerular disease. Although it has been considered as a variant of focal segmental glomerulosclerosis, the fact is that the podocyte lesions show different features with respect to the typical focal segmental glomerulosclerosis, an aspect that has been attributed to a type of podocytopathy. In CG, the podocyte lesion is typically characterised by a dysregulated podocyte phenotype, reflected by the loss of expression of mature podocyte markers. CG can be a primary disease or it can be associated with several causal factors that develop a common histopathological entity. The clinical expressiveness of CG is often characterised by the presence of a nephrotic syndrome and a rapid deterioration of the renal function than other variants of the focal segmental glomerulosclerosis. The prognosis of these patients is a rapid progression towards end-stage renal disease with poor response to treatment.

Zoledronic acid as compared with observation in multiple myeloma patients at biochemical relapse: results of the randomized AZABACHE Spanish trial

This study analyzed the anti-myeloma effect of zoledronic acid monotherapy by investigating patients at the time of asymptomatic biochemical relapse. One hundred patients were randomized to receive either zoledronic acid (4 mg iv/4 weeks, 12 doses) (n=51) or not (n=49). Experimental and control groups were well balanced for disease and prognostic features. Zoledronic acid did not show an antitumor effect according to changes in M-component. However, there were fewer symptomatic progressions in the experimental group than in the control group (34 versus 41, respectively; P=0.05) resulting in a median time to symptoms of 16 versus 10 months (P=0.161). The median time to next therapy was also slightly longer for the treated group than the untreated, control group (13.4 versus 10.1 months), although the difference was not statistically significant (P=0.360). The pattern of relapses was different for treated versus control patients: progressive bone disease (8 versus 20), anemia (24 versus 18), renal dysfunction (1 versus 2), and plasmacytomas (1 versus 1, respectively). This concurred with fewer skeletal-related events in the treated group than in the control group (2 versus 14), with a projected 4-year event proportion of 6% versus 40% (P<0.001). In summary, zoledronic acid monotherapy does not show an antitumor effect on biochemical relapses in multiple myeloma, but does reduce the risk of progression with symptomatic bone disease and skeletal complications. This trial was registered in the ClinicalTrials.gov database with code NCT01087008.

Zoledronic acid in the management of bone disease as a consequence of multiple myeloma: a review

BACKGROUND

Multiple myeloma (MM) is a haematological cancer associated with organ damage, essentially bone damage. MM continues to be considered an incurable disease and requires significant therapeutic resources.

AIM

This manuscript presents a literature review of the utility of zoledronic acid (zoledronate) in the management of bone disease in MM.

DISCUSSION

The clinical benefit of bisphosphonates in the prevention and treatment of bone disease in MM has been demonstrated in the last 10 years. A recent network meta-analysis has evaluated 20 randomised clinical trials with nearly 7000 patients with myeloma enrolled and confirms the role of these agents in the prevention of pain, bone fractures and other skeletal-related events (SRE) in MM. However, their role on survival remains unclear. Zoledronate has shown significant reductions in SRE compared with placebo or other agents with acceptable tolerability, and recent studies have shown antitumoural effects for this agent, with a marginal survival benefit demonstrated in MM.

CONCLUSIONS

Zoledronate prevents SRE in MM and presents a marginal survival benefit that deserves further investigation in controlled studies. Current clinical guidelines should be followed regarding the appropriate use of zoledronate in MM, to enhance its effects and to minimise its potential toxicity.