Abstract
The role of thalidomide, bortezomib and lenalidomide in multiple myeloma patients presenting with renal impairment was evaluated in 133 consecutive newly diagnosed patients who were treated with a novel agent-based regimen. A significant improvement of renal function (⩾renalPR (renal partial response)) was observed in 77% of patients treated with bortezomib, in 55% with thalidomide and in 43% with lenalidomide (P=0.011). In multivariate analysis, bortezomib-based therapy was independently associated with a higher probability of renal response compared with thalidomide- or lenalidomide-based therapy. Other important variables included eGFR (estimated glomerular filtration rate) ⩾30 ml/min, age ⩽65 years and myeloma response. Patients treated with bortezomib achieved at least renalPR in a median of 1.34 months vs 2.7 months for thalidomide and >6 months for lenalidomide-treated patients (P=0.028). In multivariate analysis bortezomib-based therapy, higher doses of dexamethasone (⩾160 mg during the first month of treatment), an eGFR ⩾30 ml/min and age ⩽65 years were independently associated with shorter time to renal response. In conclusion, bortezomib-based therapies may be more appropriate for the initial management of patients with myeloma-related renal failure; however, thalidomide and lenalidomide are also associated with significant probability of improvement of their renal function.
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Prof Dimopoulos has received honoraria from Celgene, Orthobiotech and Janssen-Cilag. Dr Terpos has received honoraria from Celgene. The other authors declare no conflict of interest.
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Dimopoulos, M., Roussou, M., Gkotzamanidou, M. et al. The role of novel agents on the reversibility of renal impairment in newly diagnosed symptomatic patients with multiple myeloma. Leukemia 27, 423–429 (2013). https://doi.org/10.1038/leu.2012.182
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DOI: https://doi.org/10.1038/leu.2012.182
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