Contributions
Abstract: PB2244
Type: Publication Only
Background
Renal involvement in myeloma is a serious complication which occurs in 20-30% of patients. In 10% of patients, it is severe enough to require dialysis. Historically outcome to patients with myeloma and renal failure have been poor with median survival of less than 1 year. Prognosis depends upon the reversibility of renal function with a survival similar to other patients in whom creatinine returns to normal. With the advent of novel agents like bortezomib and thalidomide, which can be safely given in these patients, remission rates and renal recovery rates have significantly improved.
Aims
To study the outcomes in patients of multiple myeloma presenting with renal failure treated with bortezomib based triple drug regimens treated at our centre.
Methods
This is a retrospective study in which 20 patients treated at the Sir Ganga Ram hospital, New Delhi, India with diagnosis of MM and renal dysfunction and at least six months of follow up were enrolled from January 2015 to June 2017. Demographic data, baseline serum creatinine, hemoglobin, serum calcium level, M protein type and level, bone marrow plasma cells, need for dialysis were recorded. Bortezomib plus Thalidomide plus dexamethasone (BTD) and Cyclophosphamide plus Bortezomib plus dexamethasone (CyBorD) were the two regimens employed in non-random fashion on treating physician’s discretion.
Results
The mean age of the patients was 53.9 years. The median baseline serum creatinine was 5.05 mg/dL (2.79–15.39). Anemia (hemoglobin <10 g/dL) was noted in 70 % and hypercalcemia (calcium > 11mg/dL) in 40 % of patients. Immunofixation revealed myeloma to be Ig G in 10/20 (50%), Ig A in 7/20 (35%) and light chain only myeloma in 3/20 (15%) patients. BTD and CyBorD were used in 12 (60%) and 8 (40%) of patients respectively with high dose dexamethasone (40mg/day for 4 days) given in first cycle to all patients. Hemodialysis was performed in 10 patients (50%) and two of them underwent high cut off (HCO) dialysis. Serum free light chain levels returned to normal after 4 sessions of 8 hours each of HCO dialysis. Serum creatinine came to normal level in all (80%) patients except four patients after 4 cycles of chemotherapy. Two (10%) of them remained dialysis dependant. Six patients (30%), who achieved a very good partial response (VGPR) after 4 cycles of bortezomib based chemotherapy but then suffered early relapse and died of progressive disease. The median progression free survival has not reached after 18 months of follow up (range 6-32 months). Six patients (30%) underwent autologous stem cell transplantation and continue to be complete remission. Median progression free survival in patients who underwent transplant (not reached after 25 months of follow up) vs non- transplanted group is (10.5 months).
Conclusion
In our patients with the incorporation of novel agents including bortezomib and thalidomide, outcome of patients with myeloma with renal failure has improved. Moreover, autologous transplant can further improve outcome in carefully selected patients. Longer follow up is needed to determine exact benefit of these agents in improving overall survival of these patients.
Session topic: 14. Myeloma and other monoclonal gammopathies - Clinical
Keyword(s): bortezomib, Myeloma, Renal failure
Abstract: PB2244
Type: Publication Only
Background
Renal involvement in myeloma is a serious complication which occurs in 20-30% of patients. In 10% of patients, it is severe enough to require dialysis. Historically outcome to patients with myeloma and renal failure have been poor with median survival of less than 1 year. Prognosis depends upon the reversibility of renal function with a survival similar to other patients in whom creatinine returns to normal. With the advent of novel agents like bortezomib and thalidomide, which can be safely given in these patients, remission rates and renal recovery rates have significantly improved.
Aims
To study the outcomes in patients of multiple myeloma presenting with renal failure treated with bortezomib based triple drug regimens treated at our centre.
Methods
This is a retrospective study in which 20 patients treated at the Sir Ganga Ram hospital, New Delhi, India with diagnosis of MM and renal dysfunction and at least six months of follow up were enrolled from January 2015 to June 2017. Demographic data, baseline serum creatinine, hemoglobin, serum calcium level, M protein type and level, bone marrow plasma cells, need for dialysis were recorded. Bortezomib plus Thalidomide plus dexamethasone (BTD) and Cyclophosphamide plus Bortezomib plus dexamethasone (CyBorD) were the two regimens employed in non-random fashion on treating physician’s discretion.
Results
The mean age of the patients was 53.9 years. The median baseline serum creatinine was 5.05 mg/dL (2.79–15.39). Anemia (hemoglobin <10 g/dL) was noted in 70 % and hypercalcemia (calcium > 11mg/dL) in 40 % of patients. Immunofixation revealed myeloma to be Ig G in 10/20 (50%), Ig A in 7/20 (35%) and light chain only myeloma in 3/20 (15%) patients. BTD and CyBorD were used in 12 (60%) and 8 (40%) of patients respectively with high dose dexamethasone (40mg/day for 4 days) given in first cycle to all patients. Hemodialysis was performed in 10 patients (50%) and two of them underwent high cut off (HCO) dialysis. Serum free light chain levels returned to normal after 4 sessions of 8 hours each of HCO dialysis. Serum creatinine came to normal level in all (80%) patients except four patients after 4 cycles of chemotherapy. Two (10%) of them remained dialysis dependant. Six patients (30%), who achieved a very good partial response (VGPR) after 4 cycles of bortezomib based chemotherapy but then suffered early relapse and died of progressive disease. The median progression free survival has not reached after 18 months of follow up (range 6-32 months). Six patients (30%) underwent autologous stem cell transplantation and continue to be complete remission. Median progression free survival in patients who underwent transplant (not reached after 25 months of follow up) vs non- transplanted group is (10.5 months).
Conclusion
In our patients with the incorporation of novel agents including bortezomib and thalidomide, outcome of patients with myeloma with renal failure has improved. Moreover, autologous transplant can further improve outcome in carefully selected patients. Longer follow up is needed to determine exact benefit of these agents in improving overall survival of these patients.
Session topic: 14. Myeloma and other monoclonal gammopathies - Clinical
Keyword(s): bortezomib, Myeloma, Renal failure