Induction Therapy with Novel Agents and Autologous Stem Cell Transplant Overcomes the Adverse Impact of Renal Impairment in Multiple Myeloma

DOI

10.2991/chi.d.190805.003How to use a DOI?

Keywords

Multiple myeloma; Renal impairment; Autologous stem cell transplantation; Real world experience; Survival

Abstract

We investigated the impact of renal impairment (RI) on the outcome in multiple myeloma (MM) patients following induction and autologous stem cell transplantation (ASCT). Among 349 patients who received a first ASCT for MM, 86 (24.6%) had RI at diagnosis, defined as estimation of glomerular filtration rate (eGFR) <40 mL/min/1.73 m² according to the modification of diet in renal disease (MDRD) formula. Post induction reversal of renal function occurred in 68 (79%) patients including complete renal response in 37.2%. Two hundred and fifty-one patients had received novel agents for induction; posttransplant complete response (CR) rates were 71.4% for patients with renal impairment (RI) versus 67.2% in those without RI, p = 0.23. The quality of stem cell collection and days to engraftment were similar except that patients with RI required higher transfusion numbers of packed red cells (p < 0.002) and platelets (p < 0.007). The median overall survival (OS) was 96 months (95% confidence interval [CI] 72.80–119.20) for patients with eGFR ≥40 mL/min, n = 195) versus 62 months (95% CI 28.7–95.3) for 56 patients with RI (eGFR <40 mL/min), p = 0.15. The 5-year OS was 64.6% versus 54.4%, respectively. The median progression-free survival (PFS) was 52 months (95% CI 36.3–67.7) for patients with eGFR ≥40 mL/min versus “not reached” for those with eGFR <40 mL/min p = 0.87; and the 5-year PFS was 48.1% versus 51%, respectively. We conclude that induction with novel agents results in reversal of renal dysfunction in the majority of patients. Consolidation with Hemopoietic Stem Cell Transplantation (HSCT) overcomes the adverse impact of RI on survival.

Copyright

© 2019 International Academy for Clinical Hematology. Publishing services by Atlantis Press International B.V.

Open Access

This is an open access article distributed under the CC BY-NC 4.0 license (http://creativecommons.org/licenses/by-nc/4.0/).

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TY  - JOUR
AU  - Lalit Kumar
AU  - Santosh Kumar Chellapuram
AU  - Ramavat Dev
AU  - Ankur Varshneya
AU  - Satyajit Pawar
AU  - Aparna Sharma
AU  - Anjali Mookerjee
AU  - Ranjit Kumar Sahoo
AU  - Prabhat Singh Malik
AU  - Atul Sharma
AU  - Ritu Gupta
AU  - Omdutta Sharma
AU  - Ahitagni Biswas
AU  - Rakesh Kumar
AU  - Sanjay Thulkar
AU  - Sauumyaranjan Mallick
PY  - 2019
DA  - 2019/08/23
TI  - Induction Therapy with Novel Agents and Autologous Stem Cell Transplant Overcomes the Adverse Impact of Renal Impairment in Multiple Myeloma
JO  - Clinical Hematology International
SP  - 205
EP  - 219
VL  - 1
IS  - 4
SN  - 2590-0048
UR  - https://doi.org/10.2991/chi.d.190805.003
DO  - 10.2991/chi.d.190805.003
ID  - Kumar2019
ER  -