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Recommendations and Guidelines for Bone-related Therapy Treatment
Last Updated: Wednesday, June 12, 2024
Yi (Lisa) Hwa, APRN, DNP, CNP, FAPO, and Amie Fonder, MS, PA-C, discuss bone-directed therapy, such as bisphosphonate or denosumab, and the difficulty in assessing which one to use, how frequently it should be given, and in what form. They also review two case studies, one involving a 66-year-old female with relapsed disease and the second concerning a 68-year-old male with smoldering multiple myeloma. In addition, Lisa and Amie share information on skeletal-related events, current treatment guidelines and recommendations, and the Medical Research Council Myeloma IX trial.
Meet the faculty
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Yi (Lisa) Hwa
DNP, C-NP
Mayo Clinic College of Medicine and Science
Yi (Lisa) Hwa, DNP, C-NP, is an associate professor at Mayo Clinic College of Medicine and Science and program director of the Mayo Clinic NP/PA Hematology/Oncology Fellowship. She has spoken at multiple NCCN Nursing Forums and annual conferences, as well as other national and international conferences. She has authored/co-authored over 100 peer-reviewed articles.
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Amie Fonder
MS, PA-C
Mayo Clinic
Amie Fonder, MPAS, PA-C, is a hematology physician assistant at Mayo Clinic, specializing in plasma cell disorders. She has presented at regional and national conferences, including the NCCN annual meeting and the inaugural Mayo Clinic RISE for Equity conference, and has a strong interest in diversity, equity, and inclusion initiatives.
References
- Terpos E, Berenson J, Cook RJ, Lipton A, Coleman RE. Prognostic variables for survival and skeletal complications in patients with multiple myeloma osteolytic bone disease. Leukemia. 2010;24(5):1043-1049. https://doi.org/10.1038/leu.2010.62
- NCCN Guidelines Version 3.2023, Multiple Myeloma © 2023 National Comprehensive Cancer Network® (NCCN®), All rights reserved.
- Terpos E, Zamagni E, Lentzsch S, et al. Treatment of multiple myeloma-related bone disease: recommendations from the Bone Working Group of the International Myeloma Working Group. Lancet Oncol. 2021;22(3):e119-e130. https://doi.org/10.1016/s1470-2045(20)30559-3
- Drugs approved for multiple myeloma. Cancer.gov. Published September 18, 2023. https://www.cancer.gov/about-cancer/treatment/drugs/multiple-myeloma
- Center for Drug Evaluation and Research. FDA approves first interchangeable biosimilars to Prolia and Xgeva to treat certain types of osteoporosis and prevent bone events in cancer. U.S. Food and Drug Administration. https://www.fda.gov/drugs/news-events-human-drugs/fda-approves-first-interchangeable-biosimilars-prolia-and-xgeva-treat-certain-types-osteoporosis-and
- Morgan GJ, Child JA, Gregory WM, et al. Effects of zoledronic acid versus clodronic acid on skeletal morbidity in patients with newly diagnosed multiple myeloma (MRC Myeloma IX): Secondary outcomes from a randomised controlled trial. Lancet Oncol. 2011;12(8):743-752. https://doi.org/10.1016/s1470-2045(11)70157-7
- Anastasilakis AD, Makras P, Yavropoulou MP, Tabacco G, Naciu AM, Palermo A. Denosumab discontinuation and the rebound phenomenon: A narrative review. J Clin Med. 2021;10(1):152. Published 2021 Jan 4. https://doi.org/10.3390/jcm10010152
- Himelstein AL, Foster JC, Khatcheressian JL, et al. Effect of longer-interval vs standard dosing of zoledronic acid on skeletal events in patients with bone metastases: A randomized clinical trial. JAMA. 2017;317(1):48-58. https://doi.org/10.1001/jama.2016.19425
- Gimsing P, Carlson K, Turesson I, et al. Effect of pamidronate 30 mg versus 90 mg on physical function in patients with newly diagnosed multiple myeloma (Nordic Myeloma Study Group): A double-blind, randomised controlled trial. Lancet Oncol. 2010;11(10):973-982. https://doi.org/10.1016/s1470-2045(10)70198-4