Contributions
Abstract: PB2197
Type: Publication Only
Background
Renal failure is a common initial presentation of multiple myeloma (MM) and causes significant morbidity and mortality.
Aims
This study aimed to investigate the factors associated with renal failure and renal recovery in MM.
Methods
The clinical features and prognostic factors were retrospectively analyzed for 169 newly diagnosed MM patients at single center. Statistical analyzes were performed using chi-square test using SPSS version 16.0 (SPSS Inc., Chicago, IL, USA). A value of less than 0.05 was considered significant.The patients with renal failure (Cre ≥ 2mg/dl) at diagnosis were compared with the cases with normal renal function (Cre< 2 mg/dl). Patients with renal failure at diagnosis were further analyzed with regards to renal function recovery after 2 and 4 cycles of anti-myeloma treatment.
Results
The median age of the patient population was 64.8 (39-88) years with male/female 98/71. Forty (23.7%) patients presented with renal failure and 19 patients required hemodialysis. According to the International Scoring System, 43(25.4%) patients had low (I), 46(27.2%) patients had intermediate (II), and 80(47.3%) patients had high (III) ISS score. There were no significant difference between the patients presenting with normal renal function (RN) and the patients presenting with renal failure (RF) in terms of age, gender, bone involvement, the ratio of first line bortezomib containing regimen. Compared with the RN group significantly more patients in RF group had light chain myeloma (p=0.028), high ISS (p=0.003), elevated serum lactate dehydrogenase value (p=0.001), initial hypercalcemia (p=0.001) and anemia (p=0.002). Response rates (≥ partial response (PR)) after 2 cycles of anti-myeloma treatment and referral to high dose therapy and autologous transplantation were similar in both groups. However, in the RN group, the ratio of patients achieving ≥ PR after 4 cycles of treatment was higher than RF group (p=0.019). Sixteen (42%) of the forty patients with renal failure at the time of initial diagnosis fully recovered after first line anti-myeloma treatment. Patients whose renal functions recovered (RFc) were compared with the patients whose renal functions did not recover (RFnc). There was no statistically significant difference between the RFc and RFnc groups in terms of age, gender, ISS, serum lactate dehydrogenase level, hypercalcemia, anemia, bone involvement and initial requirement for hemodialysis. Response (≥ PR) to 2 cycles of anti-myeloma treatment was similar in each group. On the other hand, having light chain myeloma (p=0.012) and lambda light chain (p=0.002) had negative impact on renal function recovery. Fourteen of the 27 patients (51.9%) who received bortezomib containing first line treatment had renal function recovery. Renal function recovery was significantly associated with the use of bortezomib in first line therapy (p=0.004).
Conclusion
Initial presentation with renal failure is a poor prognostic feature and has negative impact on response to anti-myeloma treatment. On the other hand, renal function recovery is not always parallel to myeloma response. Along with sufficient supportive therapy, having a non-light chain myeloma and prompt initiaion of bortezomib based first line treatment seem to be best indicators of renal function recovery.
Session topic: 14. Myeloma and other monoclonal gammopathies - Clinical
Keyword(s): bortezomib, Multiple Myeloma, Renal failure
Abstract: PB2197
Type: Publication Only
Background
Renal failure is a common initial presentation of multiple myeloma (MM) and causes significant morbidity and mortality.
Aims
This study aimed to investigate the factors associated with renal failure and renal recovery in MM.
Methods
The clinical features and prognostic factors were retrospectively analyzed for 169 newly diagnosed MM patients at single center. Statistical analyzes were performed using chi-square test using SPSS version 16.0 (SPSS Inc., Chicago, IL, USA). A value of less than 0.05 was considered significant.The patients with renal failure (Cre ≥ 2mg/dl) at diagnosis were compared with the cases with normal renal function (Cre< 2 mg/dl). Patients with renal failure at diagnosis were further analyzed with regards to renal function recovery after 2 and 4 cycles of anti-myeloma treatment.
Results
The median age of the patient population was 64.8 (39-88) years with male/female 98/71. Forty (23.7%) patients presented with renal failure and 19 patients required hemodialysis. According to the International Scoring System, 43(25.4%) patients had low (I), 46(27.2%) patients had intermediate (II), and 80(47.3%) patients had high (III) ISS score. There were no significant difference between the patients presenting with normal renal function (RN) and the patients presenting with renal failure (RF) in terms of age, gender, bone involvement, the ratio of first line bortezomib containing regimen. Compared with the RN group significantly more patients in RF group had light chain myeloma (p=0.028), high ISS (p=0.003), elevated serum lactate dehydrogenase value (p=0.001), initial hypercalcemia (p=0.001) and anemia (p=0.002). Response rates (≥ partial response (PR)) after 2 cycles of anti-myeloma treatment and referral to high dose therapy and autologous transplantation were similar in both groups. However, in the RN group, the ratio of patients achieving ≥ PR after 4 cycles of treatment was higher than RF group (p=0.019). Sixteen (42%) of the forty patients with renal failure at the time of initial diagnosis fully recovered after first line anti-myeloma treatment. Patients whose renal functions recovered (RFc) were compared with the patients whose renal functions did not recover (RFnc). There was no statistically significant difference between the RFc and RFnc groups in terms of age, gender, ISS, serum lactate dehydrogenase level, hypercalcemia, anemia, bone involvement and initial requirement for hemodialysis. Response (≥ PR) to 2 cycles of anti-myeloma treatment was similar in each group. On the other hand, having light chain myeloma (p=0.012) and lambda light chain (p=0.002) had negative impact on renal function recovery. Fourteen of the 27 patients (51.9%) who received bortezomib containing first line treatment had renal function recovery. Renal function recovery was significantly associated with the use of bortezomib in first line therapy (p=0.004).
Conclusion
Initial presentation with renal failure is a poor prognostic feature and has negative impact on response to anti-myeloma treatment. On the other hand, renal function recovery is not always parallel to myeloma response. Along with sufficient supportive therapy, having a non-light chain myeloma and prompt initiaion of bortezomib based first line treatment seem to be best indicators of renal function recovery.
Session topic: 14. Myeloma and other monoclonal gammopathies - Clinical
Keyword(s): bortezomib, Multiple Myeloma, Renal failure