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Hematopoietic progenitor cell transplantation toxicities in multiple myeloma patients with bisphosphonate-induced osteonecrosis of the jaw: a longitudinal cohort study

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Abstract

Purpose

There is no information regarding the toxicity associated with autologous hematopoietic progenitor cell transplantation (AHPCT) in patients with multiple myeloma (MM) who have bisphosphonate-induced osteonecrosis of the jaw (ONJ). There is also limited information regarding long-term outcome of these patients.

Methods

In this retrospective cohort study, we compared the toxicity after AHPCT in MM patients with and without ONJ. We also analyzed the response rate and overall survival of this population of patients.

Results

During the study period, 176 patients underwent AHPCT at our institution for MM. Ten patients with ONJ prior to AHPCT were matched to 40 control patients without ONJ. The incidence and severity of transplantation-associated toxicities were similar in both groups, including mucositis, 50 % in patients with ONJ vs. 68 % in controls (p = 0.889) and febrile days, median 1 vs. 3 days, respectively (p = 0.524). Myeloid engraftment and hospital length of stay were also similar between patients with ONJ and controls. There were significantly more complete remissions in patients with ONJ than in control patients (45 % vs. 15 %, p = 0.0336), but survival between the groups was not significantly different (log-rank p = 0.0818).

Conclusions

We conclude that the incidence and severity of transplantation-associated toxicities are similar in MM patients with and without ONJ. Long-term survival was also similar between both groups.

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References

  1. Berenson JR, Lichtenstein A, Porter L, Dimopoulos MA, Bordoni R, George S, Lipton A, Keller A, Ballester O, Kovacs M, Blacklock H, Bell R, Simeone JF, Reitsma DJ, Heffernan M, Seaman J, Knight RD (1998) Long-term pamidronate treatment of advanced multiple myeloma patients reduces skeletal events. Myeloma Aredia Study Group J Clin Oncol 16:593–602

    CAS  Google Scholar 

  2. Morgan GJ, Davies FE, Gregory WM, Cocks K, Bell SE, Szubert AJ, Navarro-Coy N, Drayson MT, Owen RG, Feyler S, Ashcroft AJ, Ross F, Byrne J, Roddie H, Rudin C, Cook G, Jackson GH, Child JA (2010) First-line treatment with zoledronic acid as compared with clodronic acid in multiple myeloma (MRC Myeloma IX): a randomised controlled trial. Lancet 376:1989–1999

    Article  PubMed  CAS  Google Scholar 

  3. Migliorati CA, Siegel MA, Elting LS (2006) Bisphosphonate-associated osteonecrosis: a long-term complication of bisphosphonate treatment. Lancet Oncol 7:508–514

    Article  PubMed  CAS  Google Scholar 

  4. Henry DH, Costa L, Goldwasser F, Hirsh V, Hungria V, Prausova J, Scagliotti GV, Sleeboom H, Spencer A, Vadhan-Raj S, von Moos R, Willenbacher W, Woll PJ, Wang J, Jiang Q, Jun S, Dansey R, Yeh H (2011) Randomized, double-blind study of denosumab versus zoledronic acid in the treatment of bone metastases in patients with advanced cancer (excluding breast and prostate cancer) or multiple myeloma. J Clin Oncol 29:1125–1132

    Article  PubMed  CAS  Google Scholar 

  5. Vahtsevanos K, Kyrgidis A, Verrou E, Katodritou E, Triaridis S, Andreadis CG, Boukovinas I, Koloutsos GE, Teleioudis Z, Kitikidou K, Paraskevopoulos P, Zervas K, Antoniades K (2009) Longitudinal cohort study of risk factors in cancer patients of bisphosphonate-related osteonecrosis of the jaw. J Clin Oncol 27:5356–5362

    Article  PubMed  CAS  Google Scholar 

  6. Badros A, Terpos E, Katodritou E, Goloubeva O, Kastritis E, Verrou E, Zervas K, Baer MR, Meiller T, Dimopoulos MA (2008) Natural history of osteonecrosis of the jaw in patients with multiple myeloma. J Clin Oncol 26:5904–5909

    Article  PubMed  Google Scholar 

  7. Child JA, Morgan GJ, Davies FE, Owen RG, Bell SE, Hawkins K, Brown J, Drayson MT, Selby PJ (2003) High-dose chemotherapy with hematopoietic stem-cell rescue for multiple myeloma. N Engl J Med 348:1875–1883

    Article  PubMed  CAS  Google Scholar 

  8. Attal M, Harousseau JL, Stoppa AM, Sotto JJ, Fuzibet JG, Rossi JF, Casassus P, Maisonneuve H, Facon T, Ifrah N, Payen C, Bataille R (1996) A prospective, randomized trial of autologous bone marrow transplantation and chemotherapy in multiple myeloma. Intergroupe Francais du Myelome. N Engl J Med 335:91–97

    Article  PubMed  CAS  Google Scholar 

  9. Hari PN, Majhail NS, Zhang MJ, Hassebroek A, Siddiqui F, Ballen K, Bashey A, Bird J, Freytes CO, Gibson J, Hale G, Holmberg L, Kamble R, Kyle RA, Lazarus HM, LeMaistre CF, Loberiza F, Maiolino A, McCarthy PL, Milone G, Omondi N, Reece DE, Seftel M, Trigg M, Vesole D, Weiss B, Wiernik P, Lee SJ, Rizzo JD, Mehta P (2010) Race and outcomes of autologous hematopoietic cell transplantation for multiple myeloma. Biol Blood Marrow Transplant 16:395–402

    Article  PubMed  Google Scholar 

  10. Palumbo A, Anderson K (2011) Multiple myeloma. N Engl J Med 364:1046–1060

    Article  PubMed  CAS  Google Scholar 

  11. Barasch A, Cunha-Cruz J, Curro FA, Hujoel P, Sung AH, Vena D, Voinea-Griffin AE, Beadnell S, Craig RG, DeRouen T, Desaranayake A, Gilbert A, Gilbert GH, Goldberg K, Hauley R, Hashimoto M, Holmes J, Latzke B, Leroux B, Lindblad A, Richman J, Safford M, Ship J, Thompson VP, Williams OD, Yin W (2011) Risk factors for osteonecrosis of the jaws: a case-control study from the CONDOR dental PBRN. J Dent Res 90:439–444

    Article  PubMed  CAS  Google Scholar 

  12. Walter C, Pabst A, Ziebart T, Klein M, Al-Nawas B (2011) Bisphosphonates affect migration ability and cell viability of HUVEC, fibroblasts and osteoblasts in vitro. Oral diseases 17:194–199

    Article  PubMed  CAS  Google Scholar 

  13. Pazianas M (2011) Osteonecrosis of the jaw and the role of macrophages. J Natl Cancer Inst 103:232–240

    Article  PubMed  Google Scholar 

  14. Kos M (2011) Bisphosphonates promote jaw osteonecrosis through facilitating bacterial colonisation. Med Hypotheses 77:214–215

    Article  CAS  Google Scholar 

  15. Ruggiero SL, Dodson TB, Assael LA, Landesberg R, Marx RE, Mehrotra B (2009) American Association of Oral and Maxillofacial Surgeons position paper on bisphosphonate-related osteonecrosis of the jaws—2009 update. J Oral Maxillofac Surg 67:2–12

    PubMed  Google Scholar 

  16. Blade J, Samson D, Reece D, Apperley J, Bjorkstrand B, Gahrton G, Gertz M, Giralt S, Jagannath S, Vesole D (1998) Criteria for evaluating disease response and progression in patients with multiple myeloma treated by high-dose therapy and haemopoietic stem cell transplantation. Myeloma Subcommittee of the EBMT. European Group for Blood and Marrow Transplant. Br J Haematol 102:1115–1123

    Article  PubMed  CAS  Google Scholar 

  17. Chen CY, Tsay W, Tang JL, Tien HF, Chen YC, Chang SC, Hsueh PR (2009) Epidemiology of bloodstream infections in patients with haematological malignancies with and without neutropenia. Epidemiol Infect 138:1044–1051

    Article  PubMed  Google Scholar 

  18. Al-Anazi KA, Abu Jafar S, Al-Jasser AM, Al-Shangeeti A, Chaudri NA, Al Jurf MD, Al-Mohareb FI (2008) Septic shock caused by Sphingomonas paucimobilis bacteremia in a patient with hematopoietic stem cell transplantation. Transpl Infect Dis 10:142–144

    Article  PubMed  CAS  Google Scholar 

  19. Setabutr D, Hales NW, Krempl GA (2010) Necrotizing fasciitis secondary to bisphosphonate-induced osteonecrosis of the jaw. Am J Otolaryngol 31:127–129

    Article  PubMed  Google Scholar 

  20. Berenson JR, Yellin O, Crowley J, Makary A, Gravenor DS, Yang HH, Upadhyaya GH, Flinn IW, Staszewski H, Tiffany NM, Sanani S, Farber CM, Morganstein N, Bolejack V, Nassir Y, Hilger JD, Sefaradi A, Shamouelian A, Swift RA (2010) Prognostic factors and jaw and renal complications among multiple myeloma patients treated with zoledronic acid. Am J Hematol 86:25–30

    Article  Google Scholar 

  21. Ripamonti CI, Maniezzo M, Campa T, Fagnoni E, Brunelli C, Saibene G, Bareggi C, Ascani L, Cislaghi E (2009) Decreased occurrence of osteonecrosis of the jaw after implementation of dental preventive measures in solid tumour patients with bone metastases treated with bisphosphonates. The experience of the National Cancer Institute of Milan. Ann Oncol 20:137–145

    Article  PubMed  CAS  Google Scholar 

  22. Corso A, Varettoni M, Zappasodi P, Klersy C, Mangiacavalli S, Pica G, Lazzarino M (2007) A different schedule of zoledronic acid can reduce the risk of the osteonecrosis of the jaw in patients with multiple myeloma. Leukemia 21:1545–1548

    Article  PubMed  CAS  Google Scholar 

  23. Sarasquete ME, Garcia-Sanz R, Marin L, Alcoceba M, Chillon MC, Balanzategui A, Santamaria C, Rosinol L, de la Rubia J, Hernandez MT, Garcia-Navarro I, Lahuerta JJ, Gonzalez M, San Miguel JF (2008) Bisphosphonate-related osteonecrosis of the jaw is associated with polymorphisms of the cytochrome P450 CYP2C8 in multiple myeloma: a genome-wide single nucleotide polymorphism analysis. Blood 112:2709–2712

    Article  PubMed  CAS  Google Scholar 

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The authors have no conflict of interest. None of the authors has any financial disclosures.

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Correspondence to Prakash Varadarajan.

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Varadarajan, P., Toro, J.J., Lee, S. et al. Hematopoietic progenitor cell transplantation toxicities in multiple myeloma patients with bisphosphonate-induced osteonecrosis of the jaw: a longitudinal cohort study. Support Care Cancer 20, 2969–2975 (2012). https://doi.org/10.1007/s00520-012-1429-4

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