Evolution of Bisphosphonates RELATED Osteonecrosis of the Jaw (BRONJ) IN PATIENTS with MULTIPLE MYELOMA (MM) and WALDENSTROM'S Macroglobulinemia (WM): A Retrospective STUDY

• Published in: Blood 2009-11, Vol.114 (22), p.2818-2818
• Main Authors: Andriani, Alessandro, Petrucci, Maria Teresa, Caravita, Tommaso, Montanaro, Marco, Pisani, Francesco, Coppetelli, Ugo, De Muro, Marianna, Bongarzoni, Velia, Avvisati, Giuseppe, Villivà, Nicoletta, Levi, Anna, Siniscalchi, Agostina, Agrillo, Alessandro, Gaglioti, Domenico
• Format: Article
• Language: English
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood.V114.22.2818.2818

Abstract 2818 Poster Board II-794 Bisphosphonate (BSFs) are an effective drug which have been mainly used in oncology for the treatment of solid tumour with bone metastasis, as well as for haematologic disease such as multiple myeloma (MM) and Waldenstrom's Macroglobulinemia (WM), but also prescribed in non neoplastic disease such osteoporosis and Paget's disease. As rare complications related to prolonged treatment with BSFs, an osteonecrosis of the jaw (BRONJ) in neoplastic and non neoplastic diseases is reported with an incidence between 2 and 15% as described in different casitics. The aim of this retrospective multicentric study is to describe the clinical aspects and the evolution of the osteo-necrotic lesions in a long term group of MM patients treated with BSFs. We studied retrospectively 55 patients (pts) with MM or WM who developed BRONJ followed from January 2003 to January 2009 in different haematological departments. Median age was 72 years (range 56-95), male 16/ 39 female. Immunoglobulin isotype was: 25 pts IgG-κ; 6 pts IgG-α, 12 pts IgA-κ; 3 pts IgA-γ, 5 pts IgM-κ (WM), 3 pts MM light chain κ and 1 pt MM light chain γ. All patients have been treated with BSFs for bone lesions and/or factures: Pamidronate was used in 1 pt (1,8 %), Zolendronic acid in 36 pts (65,5 %), Pamidronate followed by zolendronate in 18 pts (32,7 %). The average dose of Pamidronate was 2.022 mg (range 90-6.750 mg) and of zoledronate was 84 mg (range 4-256 mg). Anatomic localisation of the BRONJ was: mandible 29 pts (52,7%); maxilla 22 pts (40%); mandible/maxilla 4 cases (7,3 %). The most common trigger for BRONJ was dentoalveolar surgery, including extractions (43 cases-78,4%), dental implant placement (3 patients-5,4%), periodontal disease (5 cases-9 %), and in 3 patients with dental prothesis (5,4%); only 1 patient (1,8%) developed BRONJ spontaneously. All patients stopped bsf therapy after BRONJ diagnosis. After a median observation of 26 months (range 1-110 months) no death for BRONJ complication was reported. All patients were treated with conservative treatment such as antibiotic therapy. In 18 patients (32,7%) antibiotic therapy was the only treatment used. Six patients (10,9%) received antibiotic associated with surgical debridement of necrotic bone. Sixteen patients (29%) were treated with antibiotic therapy in combination with ozonotherapy and curettage; twelve patients (21, 8%) required sequestrectomy in association with antibiotic and oxygen/hyperbaric ther