James R. Berenson, MD, FACP

The outcome for patients with cryoglobulinemia has improved since the recognition that the condition is frequently associated with HCV and that elimination of this virus has therapeutic benefit for affected patients.

Cases of osteonecrosis of the jaw (ONJ) have been reported with an increasing frequency over the past few years. ONJ is most often identified in patients with cancer who are receiving intravenous bisphosphonate therapy but it has also been diagnosed in patients receiving oral bisphosphonates for nonmalignant conditions. The condition involves exposed bone of the maxilla or mandible. Although it is often associated with a recent dental surgical procedure, spontaneous ONJ can also occur. Patients commonly present with symptoms. Through case reporting and clinical experience, there is a suggestion that the incidence of ONJ in patients with cancer receiving intravenous bisphosphonates ranges between 1% and 10%. Management of ONJ focuses on maximizing oral health, conservative actions with mouth rinses, antibiotics, and avoidance of unnecessary invasive dental procedures. The currently available data on ONJ are reviewed here.

Oncologists have increasinglyrecognized that bone loss andits resultant complicationshave a major impact on the lives ofcancer patients. Bone loss in this populationmay be a consequence of directcancer involvement in the boneor of treatments that affect gonadalfunction or otherwise have a negativeimpact on bone.

Although bone pain from osteoblastic metastases can be ameliorated 50% to 80% of the time by use of intravenously or orally administered radiopharmaceuticals, we cannot accurately predict who will or will not

These four studies further establish the remarkable antitumor activity of thalidomide (Thalomid) in a variety of hematologic disorders. This drug was initially used as a nonbarbiturate sedative/hypnotic and antiemetic during pregnancy in the 1950s.

Recently, there has been much controversy over whether patients with prostate cancer should be treated with bisphosphonates not only to decrease pain, but to prevent metastasis.

Tumor-induced osteolysis or lytic bone disease is mediated by osteoclast activation. Osteoclasts can be activated directly by products produced by tumors or indirectly through other nonmalignant cells. By reducing