Results of an Italian trial testing bisphosphonates (pamidronate) on asymptomatic myeloma patients…

This morning a blog reader/friend sent me a newly-published Italian study containing the FINAL results of a trial testing intravenous pamidronate (Aredia) on 177 asymptomatic (SMM) patients. The results are very interesting…you can check them out here: http://goo.gl/2HWNV

According to the abstract, after a follow-up period of 5 years, 55 out of 88 patients in the no-pamidronate, or no-PAM, group had progressed to active myeloma…compared to 56 out of 89 patients in the PAM group. The median time to progression (note: as you read this post, please keep in mind that not ALL of these patients progressed to active myeloma…) was about the same for both groups, with, it seems to me, a very slim advantage, not statistically significant, for the control group.

Let’s see…the only really noticeable difference is that the control group had more skeletal involvement at the time of progression: 72.7% compared to 39.2%. That isn’t good, of course. In spite of that positive finding, however, the authors conclude that the administration of pamidronate in asymptomatic myeloma, while reducing bone involvement at progression, did not decrease the risk of transformation and the time to progression into overt myeloma. Indeed…

Random thought: what if the control group had taken curcumin instead of taking…nothing? There is a growing pile of scientific evidence that curcumin hinders the process of bone destruction (= it inhibits osteoclastogenesis, in more scientific terms). I have actually written a few posts on this topic (scroll down my Pages and look for “curcumin and bone loss”), but I see now that I need to update that information. A quick glance at PubMed this morning, in fact, confirmed that, since I wrote those posts, many other studies have proved curcumin’s activity against those little bone-gobbling buggers called osteoclasts…

Let’s get back to today’s topic. I have read the full study but, as I have recently stated, my new blog policy is not to quote directly from any copyrighted material…However, if I find something helpful or important for us patients in a full study…well, you can finish that sentence. 😉

The idea behind this study: bisphosphonate therapy has been shown to reduce skeletal-related events and pain in patients with active myeloma. The authors therefore wanted to see if it could also be beneficial to asymptomatic myeloma patients, in spite of the fact that, as they themselves point out, three previous clinical trials testing bisphosphonate use on SMM patients had failed. However, since the follow-up of the previous studies was too short, they decided to monitor a group of asymptomatic myeloma patients for at least five years…

Well, it turns out that their longer-term study does nothing but confirm the results of the three shorter-term studies…that is, there is NO BENEFIT in administering bisphosphonates to asymptomatic patients. Sure, there were fewer adverse skeletal issues in the PAM group at the time of progression, but there was no impact on progression to active myeloma or overall survival…Hence, the authors do not recommend the administration of PAM to asymptomatic patients…at least, on the basis of current findings…

Now, a couple of things popped into my head as I was reading this study. One is that it would have been amazingly interesting and perhaps useful to compare a group of SMM patients receiving PAM to another group receiving curcumin. What would the results have been? 

Another thing: I would also have been very curious to know the vitamin D levels of the patients in both groups…but I am sure that they were not tested. Sigh.

On that note, I would like to end with a plea…that some day soon the International Myeloma Working Group, or IMWG, will make vitamin D testing mandatory for all MM, MGUS and SMM patients, mainly based on the findings of a 2009 Mayo Clinic study: the vitamin-D-deficient myeloma patients in this study had worse outcomes than patients with normal vitamin D levels (see: http://goo.gl/sa28p), which reminds me, arrrrggggh!, that I forgot to take my vitamin D this morning!

2 Comments

  1. What do we take to relieve pain? Now no asprin, no ibuprofen or naproxen since we must protect our kidneys. Are we still able to take acetaminophen for pain?

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