Contributions
Abstract: PB2189
Type: Publication Only
Background
Different degrees of renal impairment are commonly observed in patients with multiple myeloma (MM) due to direct or indirect damage to the kidneys by plasma cells or light chains. Most of the patients do partially recover kidney function, but for those with permanent kidney impairment the treatment options can be limited, particularly in regard to the autologous stem cell transplant (ASCT).
Aims
To retrospectively review the outcome of a cohort of patients with varying degrees of renal failure, treated with ASCT.
Methods
A representative group of patients with MM, treated in the Greater Manchester area and referred to Manchester Royal Infirmary for ASCT between 1/1/2010 and 31/12/2016 have been included in this study. They have been randomly selected from over 300 patients treated with ASCT. Patients received Melphalan 200 mg/m2 or 140 mg/m2 if creatinine clearance (CrCl) <30 ml/min or serum creatinine >200 µmol/L. Time To Next Treatment (TTNT) and Overall Survival (OS) curves have been compared using log-rank test.
Results
A cohort of 158 patients was analysed. At the time of ASCT, 71 patients had CrCl ≥90 ml/min (normal), 51 patients had CrCl of 60-89 ml/min (Chronic Kidney Disease (CKD) 2), 22 patients had CrCl of 30-59 ml/min (CKD 3) and 14 patients had CrCl of ≤30 ml/min (CKD4, including 3 patients on dialysis). As expected, induction treatment differed according to CrCl: 70% patients with CKD1+2 received a Thalidomide-containing induction compared to 44% of those with CKD3+4, whilst a Bortezomib-based regimen was used in 26% vs 55%, respectively. The response after induction was similar: in the patients with CrCl ≥60 the CR was 32% (38% in patients with CrCl <60), VGPR was 48% (vs 49%), PR 18% (vs 13%), MR 1% (vs 0%) and PD 1% (vs 0%). Three months after ASCT, both groups’ responses improved: CR 43% in patients with CrCl ≥60 (vs 62%), VGPR 47% (vs 25%), PR 9% (vs 10%) and 1 patient had PD in the CrCl<60 group. These translated into a 5-year TTNT of 65.6% for the patients with CrCl ≥60 vs 50.6% for patients with CrCl <60 (HR 0.526, CI 0.255 – 1.086, p=0.0824). The 5-year OS was the same at 81.6% for both groups (HR 0.848, CI 0.365 – 1.969, p=0.701). The toxicity profile in the 2 groups was largely similar: in patients with CKD1+2 the median days of hospitalisation for ASCT was 19, compared to 20 for patients with CKD3 and 23 for those with CKD4, and the median number of days with CRP >50 mg/L was 5 and 7, respectively. Median time to engraftment showed no differences between the CKD1+2 and CKD3+4: Absolute Neutrophil Count >1x109/L in 13 vs 12.5 days, platelets >100x109/L in 19 vs 22 days and haemoglobin >10g/L after 28 vs 29 days, respectively. Rates of readmission to hospital were lower in the CKD1+2 group at 11.5% compared to 19.4% in CKD 3+4. Moreover, median days of readmission per patient were lower in CKD1+2 groups: 6.7 vs 10. Of note, sequential eGFR measurements in patients with CKD3+4 showed an improvement in kidney function over time: in patients with CKD 3 (and CKD 4) the median eGFR at diagnosis was 35 (and 12.5), pre-ASCT was 46 (and 20), 3 months after ASCT was 45.5 (and 20.5) and 12 months after ASCT was 42.0 (and 25).
Conclusion
Patients with MM and kidney impairment seem to benefit from ASCT to a similar level to patients with normal kidney function in terms of quality of response and long term survival. Patients with poorer kidney function show greater improvement in eGFR following ASCT. A higher rate of readmission has been observed in patients with kidney impairment, suggesting the need for closer follow-up in this particular population.
Session topic: 14. Myeloma and other monoclonal gammopathies - Clinical
Keyword(s): Myeloma, Renal failure, Renal impairment, Transplant
Abstract: PB2189
Type: Publication Only
Background
Different degrees of renal impairment are commonly observed in patients with multiple myeloma (MM) due to direct or indirect damage to the kidneys by plasma cells or light chains. Most of the patients do partially recover kidney function, but for those with permanent kidney impairment the treatment options can be limited, particularly in regard to the autologous stem cell transplant (ASCT).
Aims
To retrospectively review the outcome of a cohort of patients with varying degrees of renal failure, treated with ASCT.
Methods
A representative group of patients with MM, treated in the Greater Manchester area and referred to Manchester Royal Infirmary for ASCT between 1/1/2010 and 31/12/2016 have been included in this study. They have been randomly selected from over 300 patients treated with ASCT. Patients received Melphalan 200 mg/m2 or 140 mg/m2 if creatinine clearance (CrCl) <30 ml/min or serum creatinine >200 µmol/L. Time To Next Treatment (TTNT) and Overall Survival (OS) curves have been compared using log-rank test.
Results
A cohort of 158 patients was analysed. At the time of ASCT, 71 patients had CrCl ≥90 ml/min (normal), 51 patients had CrCl of 60-89 ml/min (Chronic Kidney Disease (CKD) 2), 22 patients had CrCl of 30-59 ml/min (CKD 3) and 14 patients had CrCl of ≤30 ml/min (CKD4, including 3 patients on dialysis). As expected, induction treatment differed according to CrCl: 70% patients with CKD1+2 received a Thalidomide-containing induction compared to 44% of those with CKD3+4, whilst a Bortezomib-based regimen was used in 26% vs 55%, respectively. The response after induction was similar: in the patients with CrCl ≥60 the CR was 32% (38% in patients with CrCl <60), VGPR was 48% (vs 49%), PR 18% (vs 13%), MR 1% (vs 0%) and PD 1% (vs 0%). Three months after ASCT, both groups’ responses improved: CR 43% in patients with CrCl ≥60 (vs 62%), VGPR 47% (vs 25%), PR 9% (vs 10%) and 1 patient had PD in the CrCl<60 group. These translated into a 5-year TTNT of 65.6% for the patients with CrCl ≥60 vs 50.6% for patients with CrCl <60 (HR 0.526, CI 0.255 – 1.086, p=0.0824). The 5-year OS was the same at 81.6% for both groups (HR 0.848, CI 0.365 – 1.969, p=0.701). The toxicity profile in the 2 groups was largely similar: in patients with CKD1+2 the median days of hospitalisation for ASCT was 19, compared to 20 for patients with CKD3 and 23 for those with CKD4, and the median number of days with CRP >50 mg/L was 5 and 7, respectively. Median time to engraftment showed no differences between the CKD1+2 and CKD3+4: Absolute Neutrophil Count >1x109/L in 13 vs 12.5 days, platelets >100x109/L in 19 vs 22 days and haemoglobin >10g/L after 28 vs 29 days, respectively. Rates of readmission to hospital were lower in the CKD1+2 group at 11.5% compared to 19.4% in CKD 3+4. Moreover, median days of readmission per patient were lower in CKD1+2 groups: 6.7 vs 10. Of note, sequential eGFR measurements in patients with CKD3+4 showed an improvement in kidney function over time: in patients with CKD 3 (and CKD 4) the median eGFR at diagnosis was 35 (and 12.5), pre-ASCT was 46 (and 20), 3 months after ASCT was 45.5 (and 20.5) and 12 months after ASCT was 42.0 (and 25).
Conclusion
Patients with MM and kidney impairment seem to benefit from ASCT to a similar level to patients with normal kidney function in terms of quality of response and long term survival. Patients with poorer kidney function show greater improvement in eGFR following ASCT. A higher rate of readmission has been observed in patients with kidney impairment, suggesting the need for closer follow-up in this particular population.
Session topic: 14. Myeloma and other monoclonal gammopathies - Clinical
Keyword(s): Myeloma, Renal failure, Renal impairment, Transplant