UNLABELLED: In patients with newly diagnosed lymphoma, low bone mineral density (BMD) is common at diagnosis and worsens with therapy. Our randomized phase III trial demonstrates that 2 doses of zoledronic acid (ZA) and supplementation with calcium and vitamin D effectively prevent further bone loss. BACKGROUND:Patients with lymphoma are at risk of development of bone mineral density (BMD) loss from therapy with high-dose corticosteroids and alkylating agents. Zoledronic acid (ZA), a bisphosphonate, may prevent this complication of therapy. We evaluated the effect of ZA on the change in BMD and surrogate biomarkers in patients with lymphoma receiving initial chemotherapy. PATIENTS AND METHODS: Our phase III trial randomized 74 patients with newly diagnosed lymphoma and a baseline BMD of ≥ -2.0 to receiveoral calcium and vitamin D daily with or without ZA at enrollment and at 6 months after enrollment. BMD was evaluated at baseline and 1 year after enrollment. Secondary biomarker endpoints were collected at baseline and at 3, 6, 9, and 12 months after enrollment. RESULTS: Forty-three percent of patients had baseline osteopenia. Fifty-three patients were evaluable for response: 24 received ZA and had stable BMD during the observation period, whereas 29 patients in the control group had decreased BMD (P < .05 at lumbar spine and bilateral femoral neck). Twenty-one randomized patients were not evaluable for response because of lymphoma progression or death, withdrawn consent/incomplete testing, or ineligibility. Bone biomarkers were higher in the control group at all intervals after treatment (P < .001). No fractures or intervention-related toxicities were observed during this trial. CONCLUSIONS:Newly diagnosed patients with lymphoma are at risk of low BMD, which may worsen with therapy. Treatment with ZA effectively stabilizes BMD and prevents bone loss. Our data suggest that BMD testing and prophylaxis should be considered as an early intervention for a preventable problem.
RCT Entities:
UNLABELLED: In patients with newly diagnosed lymphoma, low bone mineral density (BMD) is common at diagnosis and worsens with therapy. Our randomized phase III trial demonstrates that 2 doses of zoledronic acid (ZA) and supplementation with calcium and vitamin D effectively prevent further bone loss. BACKGROUND:Patients with lymphoma are at risk of development of bone mineral density (BMD) loss from therapy with high-dose corticosteroids and alkylating agents. Zoledronic acid (ZA), a bisphosphonate, may prevent this complication of therapy. We evaluated the effect of ZA on the change in BMD and surrogate biomarkers in patients with lymphoma receiving initial chemotherapy. PATIENTS AND METHODS: Our phase III trial randomized 74 patients with newly diagnosed lymphoma and a baseline BMD of ≥ -2.0 to receive oral calcium and vitamin D daily with or without ZA at enrollment and at 6 months after enrollment. BMD was evaluated at baseline and 1 year after enrollment. Secondary biomarker endpoints were collected at baseline and at 3, 6, 9, and 12 months after enrollment. RESULTS: Forty-three percent of patients had baseline osteopenia. Fifty-three patients were evaluable for response: 24 received ZA and had stable BMD during the observation period, whereas 29 patients in the control group had decreased BMD (P < .05 at lumbar spine and bilateral femoral neck). Twenty-one randomized patients were not evaluable for response because of lymphoma progression or death, withdrawn consent/incomplete testing, or ineligibility. Bone biomarkers were higher in the control group at all intervals after treatment (P < .001). No fractures or intervention-related toxicities were observed during this trial. CONCLUSIONS: Newly diagnosed patients with lymphoma are at risk of low BMD, which may worsen with therapy. Treatment with ZA effectively stabilizes BMD and prevents bone loss. Our data suggest that BMD testing and prophylaxis should be considered as an early intervention for a preventable problem.
Authors: R Eastell; D M Reid; J Compston; C Cooper; I Fogelman; R M Francis; D J Hosking; D W Purdie; S H Ralston; J Reeve; R G Russell; J C Stevenson; D J Torgerson Journal: J Intern Med Date: 1998-10 Impact factor: 8.989
Authors: G N Hortobagyi; R L Theriault; L Porter; D Blayney; A Lipton; C Sinoff; H Wheeler; J F Simeone; J Seaman; R D Knight Journal: N Engl J Med Date: 1996-12-12 Impact factor: 91.245
Authors: M C Hochberg; P D Ross; D Black; S R Cummings; H K Genant; M C Nevitt; E Barrett-Connor; T Musliner; D Thompson Journal: Arthritis Rheum Date: 1999-06
Authors: N Binkley; D Kimmel; J Bruner; A Haffa; B Davidowitz; C Meng; V Schaffer; J Green Journal: J Bone Miner Res Date: 1998-11 Impact factor: 6.741
Authors: J R Berenson; A Lichtenstein; L Porter; M A Dimopoulos; R Bordoni; S George; A Lipton; A Keller; O Ballester; M J Kovacs; H A Blacklock; R Bell; J Simeone; D J Reitsma; M Heffernan; J Seaman; R D Knight Journal: N Engl J Med Date: 1996-02-22 Impact factor: 91.245
Authors: Rosa Ruchlemer; Michal Amit-Kohn; Ariella Tvito; Irena Sindelovsky; Ari Zimran; David Raveh-Brawer Journal: Support Care Cancer Date: 2018-03-16 Impact factor: 3.603
Authors: Stephen Booth; Hannah Plaschkes; Amy A Kirkwood; Adam Gibb; Patrick Horgan; Claire Higham; Joanna M Oladipo; Joe Browning; Usman Khan; Bing Tseu; Lucia Chen; John Willan; Julia Wolf; Arief Gunawan; Paul Fields; Tim Ebsworth; Robert Lown; Dominic Gordon-Walker; Nimish Shah; Kim M Linton; Graham P Collins; Jaimal Kothari; Catherine Hildyard; Toby A Eyre Journal: Blood Adv Date: 2020-09-22
Authors: Li-Wen Huang; Dong Sun; Thomas M Link; Thomas Lang; Weiyun Ai; Lawrence D Kaplan; Michael A Steinman; Charalambos Andreadis Journal: Support Care Cancer Date: 2021-03-10 Impact factor: 3.603
Authors: Paw Jensen; Lasse Hjort Jakobsen; Martin Bøgsted; Joachim Baech; Simon Lykkeboe; Marianne Tang Severinsen; Peter Vestergaard; Tarec Christoffer El-Galaly Journal: Blood Adv Date: 2022-04-26
Authors: J Bodden; D Sun; G B Joseph; L-W Huang; C Andreadis; M Hughes-Fulford; T F Lang; T M Link Journal: Osteoporos Int Date: 2020-08-15 Impact factor: 5.071