Contributions
Abstract: PB2231
Type: Publication Only
Background
Renal impairment is a common and potentially life-threatening complication of multiple myeloma. Among newly diagnosed myeloma patients, 20-50% have acute kidney injury at the time of diagnosis. The commonest form of myeloma-related acute kidney injury is light chain cast nephropathy. Bortezomib/Cyclophosphamide/Dexamethasone (CyBorD) regimen is the preferred initial induction therapy in newly diagnosed myeloma patients with acute renal insufficiency.
Aims
Our study reports the renal salvage response to CyBorD induction therapy in newly diagnosed multiple myeloma patients with renal insufficiency in a tertiary hematology center in north India.
Methods
The study included 34 newly diagnosed patients of multiple myeloma with renal insufficiency (RI) between March 2016 & January 2018. RI was defined as either serum creatinine > 2 mg/dL or creatinine clearance (CrCl) < 40 mL/min related to myeloma.1 Baseline tests of renal function included serum creatinine & estimation of CrCl, serum electrolyes, calcium, phosphorus & uric acid. The investigations done for myeloma diagnosis included bone marrow aspiration+biopsy, serum protein electrophoresis, serum immunofixation & free light chain assay, β2 microglobulin & X-ray skeletal survey. Renal biopsy could be performed in two patients only. Renal insufficiency was aggressively managed with intravenous hydration (3 liters/m2/day, unless oliguric with volume overload) and intravenous dexamethasone. Induction therapy with CyBorD was initiated immediately after confirmation of myeloma diagnosis (21 days’ cycle: Bortezomib 1.3 mg/m2 intravenously on days 1,4,8,11; Cyclophosphamide 300 mg/m2 orally on days 1,8,15; and Dexamethasone 40 mg/day orally on days 1,4,8 & 11 of each cycle). Hemodialysis was performed in patients with oliguric renal failure, volume overload, or severe hyperphosphatemia unresponsive to treatment. Plasmapheresis was not performed in any of the patients. Zoledronate was deferred till normalization of renal function. Renal response to anti-myeloma therapy was defined as per International Myeloma Working Group (IMWG) criteria [Complete renal response: CrCl > 60 mL/min; Partial renal response: CrCl 30-59 mL/min].1
Results
The median patient age was 61 years (22-76 years). Majority (72%) of the patients had kappa light chain paraprotein (either kappa light chain myeloma or IgG/IgA kappa myeloma). Median serum creatinine & calcium levels at presentation were 3.1 mg/dl (2.1-11 mg/dl) & 11.2 mg/dl (8.1-15.4 mg/dl) respectively. Four patients (12%) required hemodialysis initially as per indication. Complete renal response was achieved in 94% (32/34) patients, including those who required dialysis. Two patients discontinued treatment & were lost to follow up. The median time from initiation of treatment to achievement of renal response was days (range 3 - 35 days).
Conclusion
Myeloma-related acute renal insufficiency is a medical emergency. Aggressive supportive treatment and prompt initiation of Bortezomib-based anti-myeloma therapy are the cornerstones of management. Hemodialysis is indicated in a minority of patients but can be life-saving. Bortezomib/Cyclophosphamide/dexamethasone induction regimen is associated with excellent renal salvage response in myeloma-related acute renal insufficiency.
Reference: 1. Dimopoulos MA, Sonneveld P, Leung N, et al. International Myeloma Working Group Recommendations for the Diagnosis & Management of Myeloma-Related Renal Impairment. Journal of Clinical Oncology 2016;34:13,1544-57.
Session topic: 14. Myeloma and other monoclonal gammopathies - Clinical
Keyword(s): Induction chemotherapy, Multiple Myeloma, Renal impairment
Abstract: PB2231
Type: Publication Only
Background
Renal impairment is a common and potentially life-threatening complication of multiple myeloma. Among newly diagnosed myeloma patients, 20-50% have acute kidney injury at the time of diagnosis. The commonest form of myeloma-related acute kidney injury is light chain cast nephropathy. Bortezomib/Cyclophosphamide/Dexamethasone (CyBorD) regimen is the preferred initial induction therapy in newly diagnosed myeloma patients with acute renal insufficiency.
Aims
Our study reports the renal salvage response to CyBorD induction therapy in newly diagnosed multiple myeloma patients with renal insufficiency in a tertiary hematology center in north India.
Methods
The study included 34 newly diagnosed patients of multiple myeloma with renal insufficiency (RI) between March 2016 & January 2018. RI was defined as either serum creatinine > 2 mg/dL or creatinine clearance (CrCl) < 40 mL/min related to myeloma.1 Baseline tests of renal function included serum creatinine & estimation of CrCl, serum electrolyes, calcium, phosphorus & uric acid. The investigations done for myeloma diagnosis included bone marrow aspiration+biopsy, serum protein electrophoresis, serum immunofixation & free light chain assay, β2 microglobulin & X-ray skeletal survey. Renal biopsy could be performed in two patients only. Renal insufficiency was aggressively managed with intravenous hydration (3 liters/m2/day, unless oliguric with volume overload) and intravenous dexamethasone. Induction therapy with CyBorD was initiated immediately after confirmation of myeloma diagnosis (21 days’ cycle: Bortezomib 1.3 mg/m2 intravenously on days 1,4,8,11; Cyclophosphamide 300 mg/m2 orally on days 1,8,15; and Dexamethasone 40 mg/day orally on days 1,4,8 & 11 of each cycle). Hemodialysis was performed in patients with oliguric renal failure, volume overload, or severe hyperphosphatemia unresponsive to treatment. Plasmapheresis was not performed in any of the patients. Zoledronate was deferred till normalization of renal function. Renal response to anti-myeloma therapy was defined as per International Myeloma Working Group (IMWG) criteria [Complete renal response: CrCl > 60 mL/min; Partial renal response: CrCl 30-59 mL/min].1
Results
The median patient age was 61 years (22-76 years). Majority (72%) of the patients had kappa light chain paraprotein (either kappa light chain myeloma or IgG/IgA kappa myeloma). Median serum creatinine & calcium levels at presentation were 3.1 mg/dl (2.1-11 mg/dl) & 11.2 mg/dl (8.1-15.4 mg/dl) respectively. Four patients (12%) required hemodialysis initially as per indication. Complete renal response was achieved in 94% (32/34) patients, including those who required dialysis. Two patients discontinued treatment & were lost to follow up. The median time from initiation of treatment to achievement of renal response was days (range 3 - 35 days).
Conclusion
Myeloma-related acute renal insufficiency is a medical emergency. Aggressive supportive treatment and prompt initiation of Bortezomib-based anti-myeloma therapy are the cornerstones of management. Hemodialysis is indicated in a minority of patients but can be life-saving. Bortezomib/Cyclophosphamide/dexamethasone induction regimen is associated with excellent renal salvage response in myeloma-related acute renal insufficiency.
Reference: 1. Dimopoulos MA, Sonneveld P, Leung N, et al. International Myeloma Working Group Recommendations for the Diagnosis & Management of Myeloma-Related Renal Impairment. Journal of Clinical Oncology 2016;34:13,1544-57.
Session topic: 14. Myeloma and other monoclonal gammopathies - Clinical
Keyword(s): Induction chemotherapy, Multiple Myeloma, Renal impairment