Bone Loss in Lymphoma Patients Prior to Receiving Front-line Therapy

Abstract Introduction Patients diagnosed with lymphoma are at high risk of developing osteoporosis. When treated with alkylating agents or corticosteroids, especially if the patient develops hypogonadism, the risk is further increased. Osteoporotic bone cannot easily be restored to normal levels of...

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Published in:Clinical lymphoma, myeloma and leukemia myeloma and leukemia, 2010-06, Vol.10 (3), p.E32-E32
Main Authors: Westin, Jason R, Thompson, Michael A, Cataldo, Vince D, Toth, Bela B, Sanjorjo, Perpetua, Bourgeois, Scott, Jimenez, Camilo, Murphy, William A, Fanale, Michelle, Fayad, Luis, Fowler, Nathan, Kwak, Larry, McLaughlin, Peter, Neelapu, Sattva, Pro, Barbara, Rodriguez, Alma, Shah, Jatin, Hagemeister, Fredrick B
Format: Article
Language:English
Subjects:
Hematology, Oncology and Palliative Medicine
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Summary:Abstract Introduction Patients diagnosed with lymphoma are at high risk of developing osteoporosis. When treated with alkylating agents or corticosteroids, especially if the patient develops hypogonadism, the risk is further increased. Osteoporotic bone cannot easily be restored to normal levels of strength; thus, prevention of bony loss is crucial. The percentage of healthy patients with osteoporosis dramatically increases with advanced age, suggesting that progressive bone loss is common, even without the above-mentioned cancer-related factors. Pamidronate can reduce the risk of bone loss and vertebral fractures in patients with lymphoma receiving chemotherapy. Zoledronic acid, a bisphosphonate approximately 100-fold more potent than pamidronate, has not been evaluated in patients with lymphoma. Urinary N -telopeptide cross-linked collagen type I (NTx), a marker of bone resorption, has early predictive value for long-term bony outcomes in patients treated with bisphosphonates. Bone-specific alkaline phosphatase (AP), a marker of bone formation, also correlates with response to bisphosphonate therapy. We have conducted a phase III trial to evaluate the effect of zoledronic acid on the change in bone mineral density (BMD) in patients with untreated lymphoma undergoing chemotherapy. We report the striking number of untreated lymphoma patients who present with osteopenia and thus would be at significant risk for future bone-related sequelae. Patients and Methods All patients with newly diagnosed lymphoma seen at our institution from 2005 to 2009 were evaluated for protocol eligibility. Exclusion criteria included bone fractures, BMD T-scores worse than −2.0, creatinine clearance < 60 mL/min, dental problems, and recent steroid or bisphosphonate use. Patients on study were stratified as male, premenopausal female, or postmenopausal female. Accrued patients were randomized to receive either: (1) oral calcium and vitamin D (Ca + D), or (2) Ca + D and 4 mg zoledronic acid intravenously (I.V.) at baseline and at 6 months. Urine NTx and bone-specific AP levels were measured at baseline, 3, 6, 9, and 12 months. Results To date, 46 patients have completed the study and have evaluable data. Patient characteristics include 27 male, 4 premenopausal female, 15 postmenopausal female, median age of 62 years (range, 33-80 years). Twenty-one patients had indolent lymphoma (18 follicular, 1 follicular center, 2 small lymphocytic), 19 had large B-cell lymphoma (17 diffuse lar
ISSN:2152-2650
2152-2669
DOI:10.3816/CLML.2010.n.042