Contributions
Abstract: EP1270
Type: E-Poster Presentation
Session title: Stem cell transplantation - Clinical
Background
According to the Russian register renal impairment at the time of diagnosis was noted in every fifth patient with multiple myeloma (MM). Timely induction therapy followed by autologous stem cell transplantation (ASCT) in some cases contributes to the reversibility of renal failure
Aims
To study the efficacy and safety of high dose therapy followed by ASCT in patients with MM and renal failure
Methods
A retrospective single-center study was performed, including 64 (30 males, 34 females) MM patients with renal failure at the time of diagnosis aged 19 to 65 years (median 54) underwent ASCT during a period from 2013 to 2019. At the time of diagnosis median of serum creatinine level was 462 μmol/L, and median of glomerular filtration rate was 10 ml/min/1.73 m2 (CKD-EPI). 23 patients (36%) were dialysis-dependent at the time of diagnosis. Induction therapy included bortezomib-containing regimens in all patients, immunomodulatory drugs were used in 20% of cases. Before ASCT the overall response rate (CR, VGPR, PR) was documented in 91% of cases, CR was achieved in 45% of patients. Renal response was achieved in 80% of patients (complete response – 28%). In 13 of 23 cases (57%) dialysis was stopped after induction therapy. 10 patients were dialysis-dependent at the time of ASCT. 47 patients (73%) underwent a single and 17 patients (27%) underwent a tandem ASCT (Mel 140-200 mg/m2). The analysis of complications, a requirement for transfusion therapy was carried out in 2 subgroups: subgroup A - patients without dialysis at the time of ASCT (n = 54), subgroup B - dialysis-dependent patients at the time of ASCT (n = 10).
Results
Reactivation of a herpesvirus infection was developed significantly more often in the subgroup B patients compared to the subgroup A patients (30% versus 6%, p = 0.04). Reversible toxic encephalopathy was developed significantly more often in the subgroup B patients comparison with the subgroup A patients (20% versus 0, p = 0.02).In subgroup B patients compared to subgroup A patients significant differences were observed in a requirement of the red blood cell transfusions (100% vs 37%, p = 0.001).100 days after ASCT the achievement of the overall response rate increased from 91 to 96%, the percentage of CR increased from 45% to 64%. After auto-HSCT, there was an increase in the rate of achieving complete renal responses - from 28% to 34%, however, the rate of total renal response remained within 80% (fig.1). In one case dialysis was stopped after the transplantation. So, at the time of diagnosis 23 patients were dependent on the renal replacement therapy. As a result of the treatment (induction therapy with auto-HSCT), 14 patients (61%) became hemodialysis-independent. Follow-up of these patients lasts from 1.5 to 7 years. There was no transplant-related mortality. After a median follow-up of 48 months 5-year overall survival (OS) was 70%, and 5-year progression-free survival (PFS) was 42%. We were analyzed OS and PFS depending on the dose of melphalan (140 versus 200), no statistically significant difference was obtained
Conclusion
ASCT is feasible, safe and effective method of the treatment in MM patients with severe kidney injury. Induction therapy followed by ASCT allowed reducing a requirement of dialysis from 36% at the time of diagnosis to 14% after ASCT. In our study 14 of 23 patients (61%) became dialysis independent. Overall, this work confirmed dialysis-dependent MM patients should not be excluded from high dose therapy followed by ASCT
Keyword(s): Acute renal failure, Autologous hematopoietic stem cell transplantation, Multiple myeloma, Renal impairment
Abstract: EP1270
Type: E-Poster Presentation
Session title: Stem cell transplantation - Clinical
Background
According to the Russian register renal impairment at the time of diagnosis was noted in every fifth patient with multiple myeloma (MM). Timely induction therapy followed by autologous stem cell transplantation (ASCT) in some cases contributes to the reversibility of renal failure
Aims
To study the efficacy and safety of high dose therapy followed by ASCT in patients with MM and renal failure
Methods
A retrospective single-center study was performed, including 64 (30 males, 34 females) MM patients with renal failure at the time of diagnosis aged 19 to 65 years (median 54) underwent ASCT during a period from 2013 to 2019. At the time of diagnosis median of serum creatinine level was 462 μmol/L, and median of glomerular filtration rate was 10 ml/min/1.73 m2 (CKD-EPI). 23 patients (36%) were dialysis-dependent at the time of diagnosis. Induction therapy included bortezomib-containing regimens in all patients, immunomodulatory drugs were used in 20% of cases. Before ASCT the overall response rate (CR, VGPR, PR) was documented in 91% of cases, CR was achieved in 45% of patients. Renal response was achieved in 80% of patients (complete response – 28%). In 13 of 23 cases (57%) dialysis was stopped after induction therapy. 10 patients were dialysis-dependent at the time of ASCT. 47 patients (73%) underwent a single and 17 patients (27%) underwent a tandem ASCT (Mel 140-200 mg/m2). The analysis of complications, a requirement for transfusion therapy was carried out in 2 subgroups: subgroup A - patients without dialysis at the time of ASCT (n = 54), subgroup B - dialysis-dependent patients at the time of ASCT (n = 10).
Results
Reactivation of a herpesvirus infection was developed significantly more often in the subgroup B patients compared to the subgroup A patients (30% versus 6%, p = 0.04). Reversible toxic encephalopathy was developed significantly more often in the subgroup B patients comparison with the subgroup A patients (20% versus 0, p = 0.02).In subgroup B patients compared to subgroup A patients significant differences were observed in a requirement of the red blood cell transfusions (100% vs 37%, p = 0.001).100 days after ASCT the achievement of the overall response rate increased from 91 to 96%, the percentage of CR increased from 45% to 64%. After auto-HSCT, there was an increase in the rate of achieving complete renal responses - from 28% to 34%, however, the rate of total renal response remained within 80% (fig.1). In one case dialysis was stopped after the transplantation. So, at the time of diagnosis 23 patients were dependent on the renal replacement therapy. As a result of the treatment (induction therapy with auto-HSCT), 14 patients (61%) became hemodialysis-independent. Follow-up of these patients lasts from 1.5 to 7 years. There was no transplant-related mortality. After a median follow-up of 48 months 5-year overall survival (OS) was 70%, and 5-year progression-free survival (PFS) was 42%. We were analyzed OS and PFS depending on the dose of melphalan (140 versus 200), no statistically significant difference was obtained
Conclusion
ASCT is feasible, safe and effective method of the treatment in MM patients with severe kidney injury. Induction therapy followed by ASCT allowed reducing a requirement of dialysis from 36% at the time of diagnosis to 14% after ASCT. In our study 14 of 23 patients (61%) became dialysis independent. Overall, this work confirmed dialysis-dependent MM patients should not be excluded from high dose therapy followed by ASCT
Keyword(s): Acute renal failure, Autologous hematopoietic stem cell transplantation, Multiple myeloma, Renal impairment