Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Cochrane on Bisphosphonates in Multiple Myeloma

Cochrane; 2017 Dec 18; Mhaskar, Kumar, et al

Bisphosphonates in patients with multiple myeloma (MM) reduces pathological vertebral fractures, skeletal-related events, and pain, according to a Cochrane review of 24 trials involving nearly 7,300 participants. Among the findings:

  • Bisphosphonates did not improve overall or disease progression-free survival.
  • They reduced overall fractures and fractures of the vertebra, but not non-vertebral fractures.
  • They alleviated pain, with osteonecrosis the only major adverse event (event rate of 1/1,000 patients treated).
  • Zoledronate was more efficacious than than etidronate and placebo, but it did not improve overall survival or other outcomes better than pamidronate or clodronate.
  • No specific aminobisphosphonate or non-aminobisphosphonate was found to be superior for any outcome.


Mhaskar R, Kumar A, Miladinovic B, Djulbegovic B. Bisphosphonates in multiple myeloma: An updated network meta-analysis. Cochrane Database of Systematic Reviews. 2017, Issue 12. Art. No.: CD003188. doi:10.1002/14651858.CD003188.pub4

This Week's Must Reads

Study supports long-term survival in multiple myeloma subgroup, Usmani SZ et al. Blood Cancer J. 2018 Nov 23;8(12):123

Similar VTE rates seen with tofacitinib, TNF inhibitors, Desai RJ et al. Arthritis Rheumatol. 2018;70(suppl 10), Abstract L09

Recurrence risk high regardless of VTE classification, Albertsen IE et al. Am J Med. 2018 Sep;131(9):1067-74.e4

Apixaban surpasses DOACs in very elderly patients, Deitelzweig SB et al. Circulation. 2018 Nov 6;138[suppl 1]:A14900

Sickle cell: Daily hydroxyurea safe in African children, Tshilolo L et al. ASH 2018, Abstract 3

Must Reads in Multiple Myeloma

Study supports long-term survival in multiple myeloma subgroup, Usmani SZ et al. Blood Cancer J. 2018 Nov 23;8(12):123

RNA editing contributes to myeloma pathogenesis, Teoh PJ et al. Blood. 2018;132(12):1304-17

Haploidentical allo-HCT possible even in relapsed myeloma, Sahebi F, et al. Biol Blood Marrow Transplant. 2018 Sep 20. pii: S1083-8791(18)30575-5.

Osteoporosis tied to mortality risk in women with multiple myeloma, Rosko AE et al. Clin Lymphoma Myeloma Leuk. 2018 Sep;18(9):597-602.e1.

Improved myeloma outcomes associated with having prescription drug coverage, Olszewski A et al. J Clin Oncol. 2018 Aug 16. doi: 10.1200/JCO.2018.77.8894