Use of the International System for Human Cytogenetic Nomenclature (ISCN).

months; range, 4-35 months, in the whole patient population) was significantly longer among patients experiencing ONJ compared with patients who did not show this complication (17 versus 10 months, respectively; P .01) (Figure 1). ONJ occurred in the mandible in 6 cases (66.6%); symptoms of pain, swelling, or purulent discharge were present in all but one patient who was diagnosed as having exposed bone at routine dentistry examination. Four patients had a complete response to minimally invasive treatment and 3 patients showed a partial improvement, while no improvement was observed in the last 2 patients in whom a monoclonal plasma cell infiltrate of the mandible was detected. Although patients’ follow-up was shorter than in other studies, possibly accounting for the lower incidence of ONJ compared with that reported by others,4-6 the rate of ONJ after 24 months of zoledronic acid exposure was 6.6%, a value comparable with those found in other analyses.5,7 This observation might suggest that neither antiangiogenic activity of thalidomide, nor impaired bone remodeling related to dexamethasone, nor severe immunosuppression induced by high-dose melphalan was an important additional risk factor for the development of ONJ. Bisphosphonates represent the standard of care for treatment and prevention of MM-related bone disease8; however, both physicians and patients should be aware of ONJ as a possible complication, and more attention should be paid to preventive measures.9,10 Patrizia Tosi, Elena Zamagni, Delia Cangini, Paola Tacchetti, Francesco Di Raimondo, Lucio Catalano, Alfonso D’Arco, Sonia Ronconi, Claudia Cellini, Massimo Offidani, Giulia Perrone, Michela Ceccolini, Annamaria Brioli, Sante Tura, Michele Baccarani, and Michele Cavo