Background

Renal impairment (RI) is a common complication and a negative prognostic factor in patients with Multiple Myeloma (MM). Patients with severe renal dysfunction may not benefit from optimal therapy as they are often excluded from autologous stem cell transplantation (ASCT). The aim of this study was to analyze the outcome of MM patients with prior RI undergoing ASCT and to evaluate the effect of transplant on renal and hematologic response.

Methods

From 147 eligible MM patients who underwent ASCT between 2002 and 2019, 131 were included in this single-center retrospective cohort study. Renal function (eGFR in ml/min/1.73m2 by MDRD) was evaluated at the time of MM diagnosis and prior to ASCT, as well as 30 and 100 days after ASCT. Patients were classified by renal function: A) eGFR <30; B) eGFR 30-59; or C) eGFR >60 prior to ASCT. ANOVA was used for comparison of renal function at diagnosis, at transplant, 30 days post ASCT, and 100 days post ASCT. Log rank testing was used for overall survival (OS) analysis of group A, B and C

Results:

Patients with renal dysfunction at baseline had lower ORR than controls to induction therapy, 71 v 78%. ASCT provided deepening responses to both groups, ORR 83 v 86% respectively. No renal responses were seen with ASCT, whereas 16% of patients with renal dysfunction at diagnosis had renal response prior to transplant. Of note, only 51% of patients with renal dysfunction received conditioning with Mel200, compared with 94% of control group. Overall survival benefit is seen for patients with eGFR>60 over any level of dysfunction (p = 0.0079).

Conclusion

Myeloma patients with renal dysfunction are a high risk group, and require special attention. Rapid and effective induction therapy remains an important step in reversing renal damage. In patients who do not recover kidney function, autologous stem cell transplantation should be considered, providing depth of response benefit. The conditioning regimen used for these patients warrants further investigation.

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Disclosures

Niesvizky:Takeda, Amgen, BMS, Janssen, Celgene: Consultancy, Research Funding. Coleman:Gilead, Bayer, Celgene: Consultancy, Research Funding, Speakers Bureau; Merck: Research Funding; Pharmacyclics: Speakers Bureau; Kite Pharmaceuticals: Equity Ownership. Rossi:BMS: Research Funding; Janssen, Celgene, Amgen: Consultancy.

Topics:
autologous stem cell transplant, kidney failure, multiple myeloma, transplantation, neoadjuvant therapy, prognostic factors, renal impairment, kidney, equity

Author notes

*

Asterisk with author names denotes non-ASH members.

© 2019 by The American Society of Hematology
2019
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