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Transplant Toxicities

An individualised risk-adapted protocol of pre- and post transplant zoledronic acid reduces bone loss after allogeneic stem cell transplantation: results of a phase II prospective trial

Bone Marrow Transplantation volume 52, pages 1288–1293 (2017)Cite this article

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Abstract

Bone loss occurs frequently following allogeneic haematopoietic stem cell transplantation (alloSCT). The Australasian Leukaemia and Lymphoma Group conducted a prospective phase II study of pretransplant zoledronic acid (ZA) and individualised post-transplant ZA to prevent bone loss in alloSCT recipients. Patients received ZA 4 mg before conditioning. Administration of post-transplant ZA from days 100 to 365 post alloSCT was determined by a risk-adapted algorithm based on serial bone density assessments and glucocorticoid exposure. Of 82 patients enrolled, 70 were alive and without relapse at day 100. A single pretransplant dose of ZA prevented femoral neck bone loss at day 100 compared with baseline (mean change −2.6±4.6%). Using the risk-adapted protocol, 42 patients received ZA between days 100 and 365 post alloSCT, and this minimised bone loss at day 365 compared with pretransplant levels (mean change −2.9±5.3%). Femoral neck bone loss was significantly reduced in ZA-treated patients compared with historical untreated controls at days 100 and 365. This study demonstrates that a single dose of ZA pre-alloSCT prevents femoral neck bone loss at day 100 post alloSCT, and that a risk-adapted algorithm is able to guide ZA administration from days 100 to 365 post transplant and minimise further bone loss.

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Acknowledgements

This study was supported with funding and the provision of zoledronic acid by Novartis Pharmaceuticals Australia Pty Ltd.

Author information

Authors and Affiliations

  1. Department of Clinical Haematology, Austin Hospital, Heidelberg, VIC, Australia

    A Grigg

  2. University of Melbourne, Melbourne, VIC, Australia

    A Grigg & E Wong

  3. WriteSource Medical Pty Ltd, Lane Cove, NSW, Australia

    B Butcher

  4. Australasian Leukaemia and Lymphoma Group, Richmond, VIC, Australia

    B Khodr

  5. Bone Marrow Transplant Unit, Royal Melbourne Hospital, Parkville, VIC, Australia

    A Bajel & E Wong

  6. Department of Haematology, Prince of Wales Hospital, Sydney, NSW, Australia

    M Hertzberg

  7. Department of Haematology, Alfred Hospital, Melbourne, VIC, Australia

    S Patil

  8. Wellington Hospital, Wellington, New Zealand

    A B D'Souza

  9. Christchurch Hospital, Christchurch, New Zealand

    P Ganly

  10. Monash University, Clayton, VIC, Australia

    P Ebeling

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  1. A Grigg
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on behalf of the Australasian Leukaemia and Lymphoma Group (ALLG)

Corresponding author

Correspondence to E Wong.

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Competing interests

BB received payment for statistical services from the Australasian Leukaemia and Lymphoma Group (ALLG), and received consulting fees from Novartis for other unrelated work. AB has received honoraria from Novartis. The remaining authors declare no conflict of interest.

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Supplementary Information accompanies this paper on Bone Marrow Transplantation website

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Grigg, A., Butcher, B., Khodr, B. et al. An individualised risk-adapted protocol of pre- and post transplant zoledronic acid reduces bone loss after allogeneic stem cell transplantation: results of a phase II prospective trial. Bone Marrow Transplant 52, 1288–1293 (2017). https://doi.org/10.1038/bmt.2017.108

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  • DOI: https://doi.org/10.1038/bmt.2017.108

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