Contributions
Abstract: EP1029
Type: E-Poster Presentation
Session title: Myeloma and other monoclonal gammopathies - Clinical
Background
About one-third of the multiple myeloma (MM) patient are recognized to have renal impairment (RI) at initial diagnosis of MM and up to 10% of the patients present with RI severe enough to require dialysis. The prognosis of MM with RI has improved significantly over the past decade owing to the availability of new agents (including proteasome inhibitors and immunomodulatory drugs) and improvement of the supportive care measures. A recent data revealed an upward movement of survival curves after the introduction of bortezomib into the MM treatment. However, conventional staging systems are insufficient to prognosticate MM patient with RI.
Aims
This study aimed to investigate the prognostic factors and treatment outcomes in multiple myeloma patients with chronic kidney disease (CKD) 5 or patients under dialysis.
Methods
Patients who were confirmed multiple myeloma between January, 2001 to December, 2016 and had an estimated glomerular filtration rate (eGFR) of less than 15 ml/min/1.73m2 at the time of multiple myeloma diagnosis or receiving hemo- or peritoneal dialysis at the time of multiple myeloma diagnosis were included into the study. A total of 248 patients from 17 centers participating Korean multiple myeloma working party were analyzed. Renal reversibility was defined by international myeloma working group recommendation: renal complete response (CRrenal) as best eGFR of ≥ 60 ml/min/1.73m2, renal partial response (PRrenal) of 30-59 ml/min/1.73m2, and renal minor response of 15-29 ml/min/1.73m2. Overall survival (OS) was defined by the date of MM diagnosis to the date of death by any cause or follow-up loss.
Results
Median age was 63.5 years (range, 32-91 years) and median eGFR was 8.9 ml/min/1.73m2 (1.0- 40.0 ml/min/1.73m2). 126 (50.8%) of the analyzed patients were under dialysis or were dialysated just after the diagnosis of MM. 79.4% of the patients received bortezomib and/or thalidomide (new agents group) as an induction regimen and 35.1% of the analyzed cohort underwent autologous stem cell transplantation (auto-SCT group). Dialysis stop rates were higher in the new agents group compared with no new agent group (49.5% versus 27.8%, P=0.088) and in the auto-SCT group compared with no auto-SCT group (77.6% versus 40.4%, P=0.000). With a median follow-up duration of 24.42 months (range, 0.20-134.93 months), the median OS in the total cohort was 46.83 months (95% confidence interval, CI, 29.39-64.27 months). OS was not different between the groups with or without new agents incorporated into the induction chemotherapy, but auto-SCT group showed a significantly prolonged OS compared with no auto-SCT group: 67.63 (95% CI, 36.07-99.19) vs. 40.60 months (28.94 - 52.26 months) (P=0.001). By the conventional international staging system (ISS) or revised international staging system (R-ISS), OS was not different between the groups. However, age (65 years or more), Eastern cooperative group performance status (2 or more), high risk cytogenetics by fluorescent in situ hybridization (FISH), and C-reactive protein (CRP) 1.0 mg/dL or more significantly affected OS by both univariate and multivariate analysis (Table 1).
Conclusion
Autologous stem cell transplantation in MM patients with CKD5 or under dialysis is able to effectively reverse renal function and prolong overall survival. Conventional ISS or R-ISS was insufficient to predict survival outcome in this cohort. Other prognostic markers incorporating age, performance status, cytogenetics by FISH, and CRP should be considered for patients with poor renal function.
Keyword(s): Chronic renal failure, Multiple myeloma
Abstract: EP1029
Type: E-Poster Presentation
Session title: Myeloma and other monoclonal gammopathies - Clinical
Background
About one-third of the multiple myeloma (MM) patient are recognized to have renal impairment (RI) at initial diagnosis of MM and up to 10% of the patients present with RI severe enough to require dialysis. The prognosis of MM with RI has improved significantly over the past decade owing to the availability of new agents (including proteasome inhibitors and immunomodulatory drugs) and improvement of the supportive care measures. A recent data revealed an upward movement of survival curves after the introduction of bortezomib into the MM treatment. However, conventional staging systems are insufficient to prognosticate MM patient with RI.
Aims
This study aimed to investigate the prognostic factors and treatment outcomes in multiple myeloma patients with chronic kidney disease (CKD) 5 or patients under dialysis.
Methods
Patients who were confirmed multiple myeloma between January, 2001 to December, 2016 and had an estimated glomerular filtration rate (eGFR) of less than 15 ml/min/1.73m2 at the time of multiple myeloma diagnosis or receiving hemo- or peritoneal dialysis at the time of multiple myeloma diagnosis were included into the study. A total of 248 patients from 17 centers participating Korean multiple myeloma working party were analyzed. Renal reversibility was defined by international myeloma working group recommendation: renal complete response (CRrenal) as best eGFR of ≥ 60 ml/min/1.73m2, renal partial response (PRrenal) of 30-59 ml/min/1.73m2, and renal minor response of 15-29 ml/min/1.73m2. Overall survival (OS) was defined by the date of MM diagnosis to the date of death by any cause or follow-up loss.
Results
Median age was 63.5 years (range, 32-91 years) and median eGFR was 8.9 ml/min/1.73m2 (1.0- 40.0 ml/min/1.73m2). 126 (50.8%) of the analyzed patients were under dialysis or were dialysated just after the diagnosis of MM. 79.4% of the patients received bortezomib and/or thalidomide (new agents group) as an induction regimen and 35.1% of the analyzed cohort underwent autologous stem cell transplantation (auto-SCT group). Dialysis stop rates were higher in the new agents group compared with no new agent group (49.5% versus 27.8%, P=0.088) and in the auto-SCT group compared with no auto-SCT group (77.6% versus 40.4%, P=0.000). With a median follow-up duration of 24.42 months (range, 0.20-134.93 months), the median OS in the total cohort was 46.83 months (95% confidence interval, CI, 29.39-64.27 months). OS was not different between the groups with or without new agents incorporated into the induction chemotherapy, but auto-SCT group showed a significantly prolonged OS compared with no auto-SCT group: 67.63 (95% CI, 36.07-99.19) vs. 40.60 months (28.94 - 52.26 months) (P=0.001). By the conventional international staging system (ISS) or revised international staging system (R-ISS), OS was not different between the groups. However, age (65 years or more), Eastern cooperative group performance status (2 or more), high risk cytogenetics by fluorescent in situ hybridization (FISH), and C-reactive protein (CRP) 1.0 mg/dL or more significantly affected OS by both univariate and multivariate analysis (Table 1).
Conclusion
Autologous stem cell transplantation in MM patients with CKD5 or under dialysis is able to effectively reverse renal function and prolong overall survival. Conventional ISS or R-ISS was insufficient to predict survival outcome in this cohort. Other prognostic markers incorporating age, performance status, cytogenetics by FISH, and CRP should be considered for patients with poor renal function.
Keyword(s): Chronic renal failure, Multiple myeloma