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

Policy statement on access to opioid medications, Statement on Opioid Use in Patients with Hematologic Diseases and Disorders, American Society of Hematology

FDA approves Mircera for dialysis-related anemia in pediatric patients, FDA approved-drug notice, June 7, 2018; Mircena label (Drugs@FDA)

FDA approves pembrolizumab for relapsed/refractory PMBCL, FDA Press Announcement, June 15, 2018; Keytruda Prescribing Information (Drugs@FDA)

Poor adherence to DOAC therapy requires attention, Lakkireddy D et al. Heart Rhythm 2018, Abstract B-LBCT02-03.

Red cell tranfusion may increase risk of postsurgical VTE, Goel R et al. JAMA Surg. 2018 Jun 13. doi: 10.1001/jamasurg.2018.1565

Must Reads in Multiple Myeloma

Ruxolitinib add-on boosted myeloma response, Berenson JR, et al. J Clin Oncol 36, 2018, suppl. (ASCO 2018, annual meeting of the American Society of Clinical Oncology); abstr 8005.

Refractory myeloma may respond to ruxolitinib add-on, Berenson JR, et al. J Clin Oncol 36, 2018 (suppl; abstr 8005).

Add-on ibrutinib boosted response in relapsed multiple myeloma, Chari A et al. Leuk Lymphoma. 2018 Apr 4. doi: 10.1080/10428194.2018.1443337.

Myeloma more likely to go untreated in dual Medicare-Medicaid recipients, Fakhri B et al. Clin Lymphoma Myeloma Leuk. Mar 2018;18(3):219-24.

In myeloma, go for a third transplant, Garderet L et al. Biol Blood Marrow Transplant. 2018 Feb 3. doi: 10.1016/j.bbmt.2018.01.035