Contributions
Abstract: PB2177
Type: Publication Only
Background
Renal impairment is a recognised complication of multiple myeloma (MM), ranging from mild chronic kidney disease to end-stage renal failure. The incidence of renal impairment at diagnosis of myeloma is between 20-50%; of these, approximately 10% present with severe acute kidney injury (AKI) requiring dialysis. Treatment regimens including both the proteasome inhibitor Bortezomib and Dexamethasone are now most commonly used as first line therapy in such patients. These regimens have improved the overall prognosis of these patients, where successful therapy can also result in partial or full recovery of renal function. However, these treatments also cause side effects such as peripheral neuropathy, infection and cytopenias.
Aims
We reviewed patients managed at our centre to determine whether the treatment of myeloma patients requiring renal replacement therapy (RRT) was associated with a high incidence of the above side effects, and to look for an improvement in outcomes over an 11 year period.
Methods
Patients diagnosed with MM with associated renal impairment between January 2007- December 2017 were identified. Only patients who required RRT were included in the analysis. Patient data including demographics, type of myeloma, chemotherapy regimens, associated complications, response to treatment and survival rates were obtained from electronic patient records.
Results
29 patients were identified who met the above inclusion criteria. Median age was 64 years (range 45-86). 59% patients were male; 72% were Caucasian. Median follow up time was 33 months (range 8 – 96 months).
65% (N=19) patients were treated with first line chemotherapy regimens which included Bortezomib; of these 84% showed a complete (21%) or partial (63%) response to therapy. 1 year survival was 89% (N=19), 5 year survival was 71% (N=14). Complications of therapy included thrombosis (11%), neuropathy (53%), and infection requiring hospital admission (42%). 37% of patients to-date recovered enough renal function to come off RRT.
35% (N=10) patients did not have Bortezomib as part of initial chemotherapy regimen. 50% of these patients responded to therapy; all with partial response, none with a complete response. 1 year survival was 90% (N=10), 5 year survival was 50% (N=10). Thrombosis (20%) and infection requiring hospital admission (20%) were also recognised complications. None of these patients were recorded to have experienced neuropathy. Only 10% of patients recovered renal function sufficiently to stop RRT.
Conclusion
Advances in therapies for MM have improved prognosis and quality of life for patients. The time frame of our study coincides with the introduction in this centre of Bortezomib as first-line treatment for MM in patients with renal impairment in 2010. In our cohort of patients who required RRT, Bortezomib treatment resulted in an increased likelihood of response to first line therapy, sufficient improvement of renal function to cease RRT, and improved overall survival. However, our cohort also demonstrates a larger side effect profile with Bortezomib-containing regimens, notably peripheral neuropathy and infection, thereby increasing overall morbidity for some of these patients.
Session topic: 14. Myeloma and other monoclonal gammopathies - Clinical
Keyword(s): Myeloma, Outcome, Renal failure
Abstract: PB2177
Type: Publication Only
Background
Renal impairment is a recognised complication of multiple myeloma (MM), ranging from mild chronic kidney disease to end-stage renal failure. The incidence of renal impairment at diagnosis of myeloma is between 20-50%; of these, approximately 10% present with severe acute kidney injury (AKI) requiring dialysis. Treatment regimens including both the proteasome inhibitor Bortezomib and Dexamethasone are now most commonly used as first line therapy in such patients. These regimens have improved the overall prognosis of these patients, where successful therapy can also result in partial or full recovery of renal function. However, these treatments also cause side effects such as peripheral neuropathy, infection and cytopenias.
Aims
We reviewed patients managed at our centre to determine whether the treatment of myeloma patients requiring renal replacement therapy (RRT) was associated with a high incidence of the above side effects, and to look for an improvement in outcomes over an 11 year period.
Methods
Patients diagnosed with MM with associated renal impairment between January 2007- December 2017 were identified. Only patients who required RRT were included in the analysis. Patient data including demographics, type of myeloma, chemotherapy regimens, associated complications, response to treatment and survival rates were obtained from electronic patient records.
Results
29 patients were identified who met the above inclusion criteria. Median age was 64 years (range 45-86). 59% patients were male; 72% were Caucasian. Median follow up time was 33 months (range 8 – 96 months).
65% (N=19) patients were treated with first line chemotherapy regimens which included Bortezomib; of these 84% showed a complete (21%) or partial (63%) response to therapy. 1 year survival was 89% (N=19), 5 year survival was 71% (N=14). Complications of therapy included thrombosis (11%), neuropathy (53%), and infection requiring hospital admission (42%). 37% of patients to-date recovered enough renal function to come off RRT.
35% (N=10) patients did not have Bortezomib as part of initial chemotherapy regimen. 50% of these patients responded to therapy; all with partial response, none with a complete response. 1 year survival was 90% (N=10), 5 year survival was 50% (N=10). Thrombosis (20%) and infection requiring hospital admission (20%) were also recognised complications. None of these patients were recorded to have experienced neuropathy. Only 10% of patients recovered renal function sufficiently to stop RRT.
Conclusion
Advances in therapies for MM have improved prognosis and quality of life for patients. The time frame of our study coincides with the introduction in this centre of Bortezomib as first-line treatment for MM in patients with renal impairment in 2010. In our cohort of patients who required RRT, Bortezomib treatment resulted in an increased likelihood of response to first line therapy, sufficient improvement of renal function to cease RRT, and improved overall survival. However, our cohort also demonstrates a larger side effect profile with Bortezomib-containing regimens, notably peripheral neuropathy and infection, thereby increasing overall morbidity for some of these patients.
Session topic: 14. Myeloma and other monoclonal gammopathies - Clinical
Keyword(s): Myeloma, Outcome, Renal failure