Survival by sex, stage, baseline bone disease status, and myeloma subtype. Forest plot of OS for ZOL versus CLO. *Bone disease was defined as osteolytic lesions, fracture, spinal cord compression, or radiation or surgery to bone. Patients with high-risk disease included those with the following mutations: t(4;14), t(14;16), t(14;20), del(17p13) or +1q21 (both pathways) or del(1p32) (intensive pathway). Patients with low-risk disease had the following mutation: t(11;14). CI indicates confidence interval; and ISS, International Staging System.