IJCEM Copyright © 2008-All rights reserved. Published by e-Century Publishing Corporation, Madison, WI 53711
Int J Clin Exp Med 2013;6(1):30-38

Original Article
A retrospective study of skeletal and disease-free survival benefits of zoledronic
acid therapy in patients with multiple myeloma treated with novel agents

Roberto Ria, Antonia Reale, Michele Moschetta, Giuseppe Mangialardi, Franco Dammacco, Angelo Vacca

Department of Biomedical Sciences and Human Oncology, Section of Internal Medicine and Clinical Oncology, University of Bari
Medical School, Bari, Italy. RR and AR contributed equally to this manuscript.

Received October 5, 2012; accepted November 5, 2012; Epub November 18, 2012; Published January 1, 2013

Abstract: Background: The large majority of patients with multiple myeloma develop bone lesions and typically receive
bisphosphonates to maintain bone health and prevent/delay skeletal-related events. Recent clinical data show that the
newer-generation bisphosphonate, zoledronic acid, may confer a survival benefit when combined with antimyeloma therapy. However,
clinical data describing the combination of zoledronic acid with newer antimyeloma regimens are limited. Design and Methods: This
retrospective study analyzed efficacy and safety outcomes in patients with multiple myeloma receiving first- and second-line treatment
with bortezomib, lenalidomide, or thalidomide, with or without zoledronic acid. Results: Records data from 94 patients with
Durie-Salmon stage 3A/B multiple myeloma were collated. Most patients (~80%) had bone lesions at study entry. Almost all patients
received zoledronic acid at some time during their treatment. Adding zoledronic acid was associated with a numerical, but statistically
nonsignificant, benefit in the 1-year progression-free survival rate in both the first- and second-line setting. A similar benefit was
observed on the 2-year skeletal-related event rate. Notably, combining zoledronic acid with newer antimyeloma agents was feasible,
tolerable, and did not affect the duration of antimyeloma treatment. Three cases of osteonecrosis of the jaw were reported; there were
no reports of acute renal failure. Conclusions: This retrospective analysis suggests that extended treatment with zoledronic acid in
combination with bortezomib, lenalidomide, or thalidomide is safe and tolerable in patients receiving these therapies as first- or
second-line treatment. The addition of zoledronic acid may improve both myeloma and skeletal-related outcomes. (IJCM1210008).

Keywords: Multiple myeloma, novel agents, progression-free survival, skeletal-related events, zoledronic acid


Address all correspondence to:
Dr. Roberto Ria
University of Bari Medical School
Department of Biomedical Sciences and Human Oncology
Section of Internal Medicine, Policlinico, Piazza Giulio Cesare 11
Bari, Italy I-70124.
Tel: +39.080.5593.106; Fax: +39.080.5478.859
E-mail: roberto.ria@uniba.it