1 Multiple myeloma is the second most common malignant hematologic disease in Canada The incidence of multiple myeloma in Canada is 55 per 1000000 people, and the prevalence is increasing.1 Novel therapies, such as immunomodulatory drugs and proteasome inhibitors, have increased progression-free 5-year survival from 29% in 1997 to 68% in 2014 among patients who have received autologous stem cell transplantation. 2 All patients with multiple myeloma should be referred early for assessment of transplant eligibility Eligibility for therapy, including autologous stem cell transplant, is determined not only by age and renal function, but also by comorbidities and functional status.3 All-cause mortality rates 100 days post-transplantation are similar for younger (40-60 yr) compared with older (≥ 60 yr) patients (1% v. 2%). 3 Bisphosphonates are recommended for all patients with multiple myeloma, regardless of evidence of bone disease Zoledronic acid and pamidronate prevent osteopenia, lytic disease and fractures. Dosing and frequency depend on indications and risk factors.4 Use of more potent intravenous bisphosphonates, however, increases the risk of osteonecrosis of the jaw; regular dental assessments can reduce associated risks.
NSTL
