Tolerability of Dose Escalation of Ibandronate in Patients with Multiple Myeloma and End-Stage Renal Disease: A Case Series

Background: Bone disease is a feature of multiple myeloma (MM). Many patients have compromised renal function and sometimes develop end-stage renal disease (ESRD). For these patients, presently there exists no approved bisphosphonate, which is an elementary part of the standard therapeutic regimen of MM. Patients and Methods: We evaluated the tolerability of ibandronate 2–6 mg every 4 weeks in patients with MM and ESRD receiving regular hemodialysis over 12 weeks (open-label, single-center, observational study). Ibandronate pharmacokinetics were measured until the end of the next dialysis. Adverse events were recorded. Results: 8 patients received ibandronate (average duration 5.6 months). Urinary excretion ranged from 0.15 to 341.9 μg/24 h. Mean ibandronate peak levels increased in a dose-dependent manner (2 mg: 141.4 ± 67.0 ng/ml; 4 mg: 298.5 ± 82.0 ng/ ml; 6 mg: 564.3 ± 318.9 ng/ml). No adverse events were reported. Conclusion: Based on these results and published bisphosphonate data, we have decided to offer off-label ibandronate treatment to MM patients receiving hemodialysis.