Quiz: Do Bisphosphonates for Multiple Myeloma Improve Survival?

Is the use of bisphosphonates in patients with multiple myeloma associated with improved progression-free or overall survival? Is hypertension a risk factor for carfilzomib-related cardiopulmonary toxicities? Test your knowledge in our latest quiz.

Question 1

Answer

A.True

A recent population-based study, published in Blood Advances, found that patients in Iceland who were overweight and obese at midlife are more likely to progress from MGUS to multiple myeloma, suggesting that obesity is involved in the transformation of MGUS to myeloma and potentially helping to explain the associations between obesity and myeloma, and early-adulthood obesity and myeloma mortality risk.

Question 2

Answer

B.Black

A recent analysis found that MGUS appears at an earlier age in black patients than in white patients in the United States. Before age 30, no cases of MGUS were identified among white patients, but MGUS was already present in 0.26% of black patients. Among those between 30–39 years of age, MGUS prevalence was 2.5 times higher in black patients than in white patients, and among those between 40–49 years of age, MGUS prevalence was more than six times higher among black patients. These disparities could help to explain the higher incidence rates and earlier onset of multiple myeloma among black patients.

Question 3

Answer

C. Vertebral fractures

According to a recent report by the Cochrane Haematological Malignancies Group, bisphosphonates are associated with reduced pathological vertebral fractures and pain in patients with multiple myeloma but an increased risk of developing osteonecrosis of the jaw (about 1 patient in 1,000). Zoledronate may offer better protection against vertebral fractures than placebo and the first-generation bisphosphonate etidronate, but the analysis revealed no evidence for superiority of any bisphosphonate over others in general. Direct head-to-head comparative trials are needed to determine if zoledronate is more efficacious, the authors cautioned. Bisphosphonates’ role in patient survival is unclear.

Question 4

Answer

C.Immunophenotypic and immune profiling studies are well standardized

The authors of the recommendations urged incorporation of immune phenotyping into “as many prospective studies as possible” and development of standardized immune phenotype panels to facilitate comparison of outcomes from different studies.

Question 5

Answer

B.Alcohol use

According to a 2017 consensus statement from the European Myeloma Network, risk factors for carfilzomib-related cardiopulmonary adverse events include smoking, obesity, sedentary habit, age 75 years or older, comorbidities (hypertension, peripheral vascular disease, diabetes and hypercholesterolemia), and cardiac risk factors (including heart failure, coronary artery disease, vulvar heart disease with left ventricular impairment or hypertrophy), and pretreatment with cardiotoxic agents such as anthracyclines, or concurrent treatment with high-dose anti-myeloma drugs like dexamethasone.