Bisphosphonate-associated osteonecrosis of the jaw : a review of 35 cases and anevaluation of its frequency in multiple myeloma patients

Over a period of 28 months, we observed five cases of osteonecrosis of the jaw (ONJ) in cancer patients treated with bisphosphonates (BP) at our institution. This prompted us to undertake a retrospective, multicenter study to analyse the characteristics of patients who exhibited ONJ and to define the frequency of ONJ in multiple myeloma (MM). We identified 35 cases in Gruppo Italiano Studio Linfomi centers during the period 2002-05. The median time from cancer diagnosis to the clinical onset of ONJ was 70 months. In these 35 cases of ONJ, 24 appeared 20-60 months after starting BP treatment. The time for the onset of ONJ was significantly shorter for patients treated with zoledronic acid alone than for those treated with pamidronate followed by zoledronic acid. The frequency of ONJ in the MM group during the study period was 1.9%, although the nature of the present study may have resulted in an underestimation of ONJ cases. Our analysis strongly suggested an association between the use of BP and the occurrence of ONJ, although we were unable to identify any definite risk factors with a retrospective study. The most frequently ONJ-associated clinical characteristics were chemotherapy treatment, steroid treatment, advanced age, female sex, anemia, parodonthopaties/dental procedures and thalidomide (in the case of MM patients)

Bisphosphonate-associated osteonecrosis of the jaw: a review of 35 cases and an evaluation of its frequency in multiple myeloma patients

Over a period of 28 months, we observed five cases of osteonecrosis of the jaw (ONJ) in cancer patients treated with bisphosphonates (BP) at our institution. This prompted us to undertake a retrospective, multicenter study to analyse the characteristics of patients who exhibited ONJ and to define the frequency of ONJ in multiple myeloma (MM). We identified 35 cases in Gruppo Italiano Studio Linfomi centers during the period 2002-05. The median time from cancer diagnosis to the clinical onset of ONJ was 70 months. In these 35 cases of ONJ, 24 appeared 20-60 months after starting BP treatment. The time for the onset of ONJ was significantly shorter for patients treated with zoledronic acid alone than for those treated with pamidronate followed by zoledronic acid. The frequency of ONJ in the MM group during the study period was 1.9%, although the nature of the present study may have resulted in an underestimation of ONJ cases. Our analysis strongly suggested an association between the use of BP and the occurrence of ONJ, although we were unable to identify any definite risk factors with a retrospective study. The most frequently ONJ-associated clinical characteristics were chemotherapy treatment, steroid treatment, advanced age, female sex, anemia, parodonthopaties/dental procedures and thalidomide (in the case of MM patients)

BISPHOSPHONATES (BP) RELATED OSTEONECROSIS OF THE JAW (ONJ): A LONG TERM FOLLOW UP (FU) OF A SERIES OF 35 CASES OBSERVED BY GISL

Background. In 2007 we published a review of 35 cases of BP-associated ONJ observed in cancer patients during a multicenter study performed by the GISL (Gruppo Italiano Studio Linfomi e Mielomi) in the period 2002-2005. Our study strongly suggested an association between the use of BP and the occurrence of ONJ, although we were unable to identify any definitive risk factors with a retrospective study. The most frequently ONJ-associated clinical characteristics were chemotherapy treatment, advanced age, female sex, anemia, parodonthopaties/dental procedures and thalidomide (in the case of MM patients). Aims. To update the FU of these 35 patients, evaluating ONJ evolution and the interference with the quality of life. Methods. We asked to the 14 centers that participated in the previous study, and that reported cases of ONJ, to up-date the status of the primary disease, the evolution of ONJ, and the quality of life of their pts. Results. Five patients were lost to FU. Among the remaining 30 pts, 25 were affected by multiple myeloma, and 5 by other type of neoplasia. Nineteen pts are alive (63%) and 11 patients (37%) died for progression of the primary disease. In the deceased pts the follow-up referred to the status of the ONJ just before the decease. Twenty-two are females, 8 are males with a median FU of 30 months since the diagnosis of ONJ for all patients and a median FU of 34 months for alive patients. In one patient (3%) ONJ resolved, in 11 patients (37%) the lesion is stable, and in 13 cases (43%) the lesion improved, as a result of one or more procedures. Five patients (17%) showed progression of the lesion: in 4 cases due to a fistula and in 1 case of local infection. No recurrence of the event has been reported. ONJ interfered with the ability of eating in 13 pt (43%) determining an impairment of quality of life. In 29 out of 30 (97%) BP has been suspended indefinitely, and only in 1 case the pt went on with the treatment after the diagnosis of ONJ. Conclusions. In our population ONJ showed a various range of evolution: in the majority of the cases it was stable or even improved or healed (37%,43% and 3% respectively), but even if rarely it evolved in a even worst complication like fistula and local infection. No cases of recurrence has been reported. The complication doesn’t seem to interfere with the survival of the pts, and all patients deceased for progression of the primary disease. ONJ interfere with the quality of life in particular because the lesion reduce the ability of eating. The large majority of treating physicians preferred to indefinitely discontinue BP administration regardless of the bone involvement and this could explaining why we did not observe any recurrence

Factors that predict response and disease free survival in clinically advanced follicular lymphomas.

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