Purpose To update guideline recommendations on the role of bone-modifying agents in multiple myeloma. Methods An update panel conducted a targeted systematic literature review by searching PubMed and the Cochrane Library for randomized controlled trials, systematic reviews, meta-analyses, clinical practice guidelines, and observational studies. Results Thirty-five relevant studies were identified, and updated evidence supports the current recommendations. Recommendations For patients with active symptomatic multiple myeloma that requires systemic therapy with or without evidence of lytic destruction of bone or compression fracture of the spine from osteopenia on plain radiograph(s) or other imaging studies, intravenous administration of pamidronate 90 mg over at least 2 hours or zoledronic acid 4 mg over at least 15 minutes every 3 to 4 weeks is recommended. Denosumab has shown to be noninferior to zoledronic acid for the prevention of skeletal-related events and provides an alternative. Fewer adverse events related to renal toxicity have been noted with denosumab compared with zoledronic acid and may be preferred in this setting. The update panel recommends that clinicians consider reducing the initial pamidronate dose in patients with preexisting renal impairment. Zoledronic acid has not been studied in patients with severe renal impairment and is not recommended in this setting. The update panel suggests that bone-modifying treatment continue for up to 2 years. Less frequent dosing has been evaluated and should be considered in patients with responsive or stable disease. Continuous use is at the discretion of the treating physician and the risk of ongoing skeletal morbidity. Retreatment should be initiated at the time of disease relapse. The update panel discusses measures regarding osteonecrosis of the jaw. Additional information is available at www.asco.org/hematologic-malignancies-guidelines and www.asco.org/guidelineswiki .

中文翻译：

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骨改性剂在多发性骨髓瘤中的作用：美国临床肿瘤学会临床实践指南更新

目的更新关于骨改性剂在多发性骨髓瘤中的作用的指南建议。方法 更新小组通过搜索 PubMed 和 Cochrane 图书馆的随机对照试验、系统评价、荟萃分析、临床实践指南和观察性研究，进行了有针对性的系统文献综述。结果 确定了 35 项相关研究，更新的证据支持当前的建议。建议 对于需要全身治疗的活动性症状性多发性骨髓瘤患者，无论是否有平片或其他影像学检查显示因骨质减少导致骨质溶解性破坏或脊柱压缩性骨折的证据，静脉注射帕米膦酸 90 mg 至少 2 次建议每 3 至 4 周服用 4 毫克唑来膦酸，每次至少 15 分钟。狄诺塞麦已被证明在预防骨骼相关事件方面不劣于唑来膦酸，并提供了一种替代方案。与唑来膦酸相比，狄诺塞麦与肾毒性相关的不良事件较少，在这种情况下可能是首选。更新小组建议临床医生考虑减少既往肾功能不全患者的帕米膦酸钠初始剂量。唑来膦酸尚未在严重肾功能不全患者中进行研究，因此不建议在这种情况下使用。更新小组建议骨修饰治疗持续长达 2 年。已对较低频率的给药进行了评估，对于有反应或疾病稳定的患者应考虑使用。持续使用取决于治疗医生的判断以及持续骨骼发病的风险。疾病复发时应开始重新治疗。更新小组讨论了有关颌骨坏死的措施。更多信息请访问 www.asco.org/hematologic-malignancies-guidelines 和 www.asco.org/guidelineswiki。