Bisphosphonates for myeloma patients

: Several species of bisphosphonate (BP) have been widely used as one of the standardized supportive therapy for myeloma patients, because of the efficacy evidenced by lots of prospective randomised trials showing the decreased incidence of the skeletal-related events. In addition, BPs have lots of beneficial effects on myeloma patients, including the enhancement of lymphocyte subset, and anti-myeloma effects possibly by 'indirect' effects on myeloma cells via apoptosis-inducing effects on osteoclasts, as well as 'direct' apoptosis -inducing effects on myeloma cells. On the contrary, BPs have been shown to have adverse events, including transient flu -like syndrome accompanied by fever and transient inflammatory reactions, and unexpected severe tissue damage, named 'osteonecrosis of the jaw (ONJ)'. Once ONJ developed in myeloma patients, myeloma therapies could be influenced drastically at times, because ONJ site could become infection focus and necessitate cessation of cytotoxic therapy in order to support tissue repair in situ. Prevention of ONJ might be feasible through oral hygiene, because ONJ develops almost always in patients with long-history of dental diseases.