Contributions
Abstract: PB1680
Type: Publication Only
Session title: Myeloma and other monoclonal gammopathies - Clinical
Background
Renal impairment occurs in 20 to 50% of newly diagnosed multiple myeloma (NDMM) patients. It is associated with worse outcome of the disease. The recent use of new agents and the development of novel techniques of light chain removal have been associated with improved renal and patient outcomes in MM patients. Nevertheless, dialysis-dependent patients with MM have higher mortality than other dialysis patients.
Aims
The aim of this study was to describe renal impairment in patients with MM at time of diagnosis and to investigate renal response factors and overall survival.
Methods
This retrospective study analyzed the medical records of all patients newly diagnosed with MM between January 2008 to November 2020 at the Nephrology department of the military Hospital in Morocco. Diagnosis of MM was based on the IMWG 2014 criteria. We collected patients’ data as age, sex, presenting symptoms, hematological and laboratory features. Renal impairment was defined as serum creatinine >2 mg/dl or eGFR<60 ml/min/1,73 m² and/ or elevated proteinuria/creatinuria (>0,5 g/g). We reported renal biopsy results, anti-myeloma treatment. We evaluated the hematological and renal response and overall survival. Descriptive statistics of continuous variables were presented as medians. Survival curves were constructed according to the Kaplan-Meier method, and the curves were compared using log-rank test. Cox proportional hazard analysis was used to identify factors influencing the overall survival.
Results
Fifty-five NDMM patients with initial RI were included. The median age was 60 years. Sex ratio was 2,6. Sixteen patients (29.1%) had light chain Lambda myeloma, 15 (27.3%) had monoclonal IgG kappa MM. Thirty patients had stage 5 CKD and 44 (80%) had serum creatinine 2>mg/dl. Seventeen (35.5%) patients required dialysis at the diagnosis. Twenty seven (49%) patients had a kidney biopsy. Cast nephropathy was reported in 15 cases, Randall-type monoclonal immunoglobulin deposition disease in 7 patients and renal amyloidosis was found in 5 patients. The treatment regimens included a CTD in 19 patients (35.8%), VTD in 13 patients (24.5%) and VAD in 12 patients. Seven patients were referred for stem cell transplantation. Hematologic and renal responses were observed in 31 patients (76.5%) and 34 patients (60.7%) respectively. Dialysis was withdrawn in one patient only. Patient sub-groups with and without renal response were similar in age, gender distribution, LDH levels, thrombocytopenia and histological type. Serum creatinine was >2 mg/dl in 60% of patients who did not achieve renal response versus 40% in patients achieving renal response (p=0.02). The renal response rate in the group treated with bortezomib based regimens was slightly superior compared with the group not treated with bortezomib (p=0,07). Only multivariate analysis only female sex and Bortezomib use appear to be associated with renal response. In a mean follow-up of 17 months 25 patients died (51.9%). The median overall survival from diagnosis was estimated at 35 months. In a univariate analysis, age, gender, thrombocytopenia, LDH, renal response and treatment with bortezomib were not found to influence OS. In multivariate analysis a serum creatinine > 2 mg/dl was significantly associated with decreased OS (p=0.03).
Conclusion
Our study showed a dismal outcome and a short survival in of NDMM with RI in our center. Mainly because a large proportion of our patients did not receive new agents in front line therapy and only a few were transplanted. This study emphasise also the importance of bortezomib based regimens in this setting.
Keyword(s): Multiple myeloma, Renal impairment
Abstract: PB1680
Type: Publication Only
Session title: Myeloma and other monoclonal gammopathies - Clinical
Background
Renal impairment occurs in 20 to 50% of newly diagnosed multiple myeloma (NDMM) patients. It is associated with worse outcome of the disease. The recent use of new agents and the development of novel techniques of light chain removal have been associated with improved renal and patient outcomes in MM patients. Nevertheless, dialysis-dependent patients with MM have higher mortality than other dialysis patients.
Aims
The aim of this study was to describe renal impairment in patients with MM at time of diagnosis and to investigate renal response factors and overall survival.
Methods
This retrospective study analyzed the medical records of all patients newly diagnosed with MM between January 2008 to November 2020 at the Nephrology department of the military Hospital in Morocco. Diagnosis of MM was based on the IMWG 2014 criteria. We collected patients’ data as age, sex, presenting symptoms, hematological and laboratory features. Renal impairment was defined as serum creatinine >2 mg/dl or eGFR<60 ml/min/1,73 m² and/ or elevated proteinuria/creatinuria (>0,5 g/g). We reported renal biopsy results, anti-myeloma treatment. We evaluated the hematological and renal response and overall survival. Descriptive statistics of continuous variables were presented as medians. Survival curves were constructed according to the Kaplan-Meier method, and the curves were compared using log-rank test. Cox proportional hazard analysis was used to identify factors influencing the overall survival.
Results
Fifty-five NDMM patients with initial RI were included. The median age was 60 years. Sex ratio was 2,6. Sixteen patients (29.1%) had light chain Lambda myeloma, 15 (27.3%) had monoclonal IgG kappa MM. Thirty patients had stage 5 CKD and 44 (80%) had serum creatinine 2>mg/dl. Seventeen (35.5%) patients required dialysis at the diagnosis. Twenty seven (49%) patients had a kidney biopsy. Cast nephropathy was reported in 15 cases, Randall-type monoclonal immunoglobulin deposition disease in 7 patients and renal amyloidosis was found in 5 patients. The treatment regimens included a CTD in 19 patients (35.8%), VTD in 13 patients (24.5%) and VAD in 12 patients. Seven patients were referred for stem cell transplantation. Hematologic and renal responses were observed in 31 patients (76.5%) and 34 patients (60.7%) respectively. Dialysis was withdrawn in one patient only. Patient sub-groups with and without renal response were similar in age, gender distribution, LDH levels, thrombocytopenia and histological type. Serum creatinine was >2 mg/dl in 60% of patients who did not achieve renal response versus 40% in patients achieving renal response (p=0.02). The renal response rate in the group treated with bortezomib based regimens was slightly superior compared with the group not treated with bortezomib (p=0,07). Only multivariate analysis only female sex and Bortezomib use appear to be associated with renal response. In a mean follow-up of 17 months 25 patients died (51.9%). The median overall survival from diagnosis was estimated at 35 months. In a univariate analysis, age, gender, thrombocytopenia, LDH, renal response and treatment with bortezomib were not found to influence OS. In multivariate analysis a serum creatinine > 2 mg/dl was significantly associated with decreased OS (p=0.03).
Conclusion
Our study showed a dismal outcome and a short survival in of NDMM with RI in our center. Mainly because a large proportion of our patients did not receive new agents in front line therapy and only a few were transplanted. This study emphasise also the importance of bortezomib based regimens in this setting.
Keyword(s): Multiple myeloma, Renal impairment