The American Society of Clinical Oncology (ASCO) is the world's leading professional organization representing physicians who treat people with cancer. Using the best available evidence, the ASCO expert panels identify and develop practice recommendations for specific areas of cancer care.

In September 2002, ASCO adopted a guideline, "The Role of Bisphosphonates in Multiple Myeloma," which was published in the Journal of Clinical Oncology. The conclusion of the recommendation is as follows:

"Bisphosphonates provide a meaningful supportive benefit to multiple myeloma patients with lytic bone disease. However, further research on bisphosphonates is warranted, including the following: (1) when to start and stop therapy, (2) how to integrate their use with other treatments for lytic bone disease, (3) how to evaluate their role in myeloma patients without lytic bone involvement, (4) how to distinguish between symptomatic and asymptomatic bony events, and (5) how to better determine their cost-benefit consequence."¹

Specific points of the guidelines include¹:

• With lytic disease on plain radiograph
  – Pamidronate intravenously (IV) infused over 2 hours every 3 to 4 weeks
  – Zoledronic acid IV infused over 15 minutes every 3 to 4 weeks
• Monitoring
  – Reassess renal function in all patients every 3 to 6 months
  – Use in patients with preexisting renal disease and serum creatinine >265 µmol/L or >3.0 mg/dL has not been carefully assessed
• Duration of therapy
  – Continue until substantial decline in performance status or inconvenience of therapy outweighs benefit
• With osteopenia based on plain radiograph or bone mineral density
  – Reasonable to start therapy in absence of radiographic lytic disease
• Bone pain control secondary to bony involvement
  – Recommended for pain resulting from osteolysis and as adjunctive treatment for patients receiving radiation therapy, analgesics, or surgery to stabilize fractures or potential fractures

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