Induction Therapy with Novel Agents and Autologous Stem Cell Transplant Overcomes the Adverse Impact of Renal Impairment in Multiple Myeloma
- 10.2991/chi.d.190805.003How to use a DOI?
- Multiple myeloma; Renal impairment; Autologous stem cell transplantation; Real world experience; Survival
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.
- © 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 -