The combination of lenalidomide and dexamethasone reduces bone resorption in responding patients with relapsed/refractory multiple myeloma but has no effect on bone formation: final results on 205 patients of the Greek myeloma study group.
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| Abstract |
The combination of lenalidomide plus dexamethasone (RD) is very effective for patients with relapsed/ refractory myeloma. However, the effect of RD on bone metabolism has not been previously evaluated in these patients. To address this issue, we initially performed a retrospective study in 106 consecutive patients with relapsed or refractory myeloma who received RD. We measured the following bone indices on Cycle 1/Day 1 and then on Cycles 3 and 6/Day 28: dickkopf-1 (Dkk-1), sRANKL, osteoprotegerin (OPG), bone resorption markers (C-telopeptide of collagen type-I, CTX and TRACP-5b) and bone formation markers (bone-specific alkaline phosphatase-bALP and osteocalcin). RD produced a reduction of CTX only in responders, with no effect on bone formation. To validate these results, we then evaluated prospectively 99 patients who received either RD (n550) or VRD (bortezomib + RD, n549). RD reduced CTX, mainly in responders but showed no effect on bone formation, confirming the result of the retrospective study. However, the addition of bortezomib to RD (VRD arm) reduced Dkk-1, sRANKL/OPG, and CTX, while it increased bALP and OC after six cycles of therapy. These changes were irrespective of treatment response, which was similar between treatment arms. No skeletal-related events were observed in the VRD arm while two, nonresponding patients treated with RD developed a vertebral fracture. We conclude that RD reduces bone resorption only in responding patients with relapsed/refractory myeloma but has no effect on bone formation. Combination with bortezomib, which enhances bone formation, seems to be preferred for the management of myeloma patients with osteolytic disease.
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| Authors | Evangelos Terpos, Dimitrios Christoulas, Efstathios Kastritis, Eirini Katodritou, Athanasios Papatheodorou, Anastasia Pouli, Marie-Christine Kyrtsonis, Eurydiki Michalis, Xenophon Papanikolaou, Maria Gkotzamanidou, Efstathios Koulieris, Maria Gavriatopoulou, Konstantinos Zervas, Meletios A Dimopoulos, Greek Myeloma Study Group |
| Journal | American journal of hematology (Am J Hematol) Vol. 89 Issue 1 Pg. 34-40 (Jan 2014) ISSN: 1096-8652 [Electronic] United States |
| PMID | 23983166 (Publication Type: Journal Article) |
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