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Blood, 15 October 2000, Vol. 96, No. 8, pp. 2697-2702
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Biochemical markers of bone turnover following high-dose
chemotherapy and autografting in multiple myeloma
Richard E. Clark,
Angela J. Flory,
Edwina M. Ion,
Barry E. Woodcock,
Brian H. Durham, and
William D. Fraser
From the Jose Carreras BMT Unit, Department of
Haematology and Department of Clinical Chemistry, Royal Liverpool
University Hospital, Liverpool, England, and the Department of
Haematology, Southport District General Hospital, Southport, England.
The effect of high-dose chemotherapy and autografting on bone
turnover in myeloma is not known. A study of 32 myeloma patients undergoing blood or marrow transplant (BMT), conditioned with high-dose melphalan, was done. Bone resorption was assessed by urinary
free pyridinoline (fPyr) and deoxypyridinoline (fDPyr), expressed as a
ratio of the urinary creatinine concentration. Bone formation was
assessed by serum concentration of procollagen 1 extension peptide
(P1CP) and bone-specific alkaline phosphatase (BSAP). Eighteen cases
had normal fPyr and fDPyr at transplant, and in all but one of these
cases the level remained normal throughout subsequent follow-up. In
contrast, in 14 cases urinary fPyr and fDPyr levels were increased at
transplant. In these cases, both fPyr and fDPyr fell to normal levels
over the next few months (P = .0009 and .0019, respectively). fPyr and fDPyr levels at transplant and their trends
post-BMT were unrelated to the use of pre-BMT or post-BMT
bisphosphonate or post-BMT interferon. Nine cases had elevated P1CP or
BSAP at transplant, which rapidly normalized. In most patients there
was an increase in P1CP and/or BSAP several months post-transplant. In
conclusion, increased osteoclast activity may be present even in
apparent plateau phase of myeloma. High-dose chemotherapy with
autografting may normalize abnormal bone resorption, although the
effect may take several weeks to emerge and may be paralleled by
increased osteoblast activity. The findings provide biochemical
evidence that autografting may help normalize the abnormal bone
turnover characteristic of myeloma.
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