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Plasma Cell Disorders

Autologous hematopoietic cell transplantation for multiple myeloma patients with renal insufficiency: a center for international blood and marrow transplant research analysis

Bone Marrow Transplantation volume 52, pages 1616–1622 (2017)Cite this article

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Abstract

Autologous hematopoietic cell transplantation (AHCT) in multiple myeloma (MM) patients with renal insufficiency (RI) is controversial. Patients who underwent AHCT for MM between 2008 and 2013 were identified (N=1492) and grouped as normal/mild (⩾60 mL/min), N=1240, moderate (30–59), N=185 and severe RI (<30), N=67 based on Modification of Diet in Renal Disease. Multivariate analyses of non-relapse mortality (NRM), relapse, PFS and overall survival (OS) were performed. Of the 67 patients with severe RI, 35 were on dialysis prior to AHCT. Patients received melphalan 200 mg/m2 (Mel 200) in 92% (normal/mild), 75% (moderate) and 33% (severe) RI; remainder received 140 mg/m2 (Mel 140). Thirty four of 35 patients with severe RI achieved post-AHCT dialysis independence. The 5-year PFS for normal, moderate and severe RI was 35 (95% CI, 31–38)%, 40 (31–49)% and 27 (15–40)%, respectively, (P=0.42); 5-year OS for normal, moderate and severe RI was 68 (65–71)%, 68 (60–76)% and 60 (46–74)%, respectively, (P=0.69). With moderate RI, 5-year PFS for high-dose melphalan 140 mg/m2 was 18 (6–35)% and for Mel 200 was 46 (36–57)% (P=0.009). With severe RI, 5-year PFS Mel 140 was 25 (11–41) % and for Mel 200 was 32 (11–58)% (P=0.37). We conclude that AHCT is safe and effective in patients with MM with RI.

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Acknowledgements

This publication is funded in part by the Research and Education Program Fund, a component of the Advancing a Healthier Wisconsin endowment at the Medical College of Wisconsin and by KL2TR001438 from the Clinical and Translational Science Award program of the National Center for Advancing Translational Sciences (D’Souza, A). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. The CIBMTR is supported by Public Health Service Grant/Cooperative Agreement 5U24-CA076518 from the National Cancer Institute (NCI), the National Heart, Lung and Blood Institute (NHLBI) and the National Institute of Allergy and Infectious Diseases (NIAID); a Grant/Cooperative Agreement 5U10HL069294 from NHLBI and NCI; a contract HHSH250201200016C with Health Resources and Services Administration (HRSA/DHHS); two Grants N00014-15-1-0848 and N00014-16-1-2020 from the Office of Naval Research; and grants from Alexion; *Amgen, Inc.; Anonymous donation to the Medical College of Wisconsin; Astellas Pharma US; AstraZeneca; Be the Match Foundation; *Bluebird Bio, Inc.; *Bristol Myers Squibb Oncology; *Celgene Corporation; Cellular Dynamics International, Inc.; *Chimerix, Inc.; Fred Hutchinson Cancer Research Center; Gamida Cell Ltd.; Genentech, Inc.; Genzyme Corporation; *Gilead Sciences, Inc.; Health Research, Inc. Roswell Park Cancer Institute; HistoGenetics, Inc.; Incyte Corporation; Janssen Scientific Affairs, LLC; *Jazz Pharmaceuticals, Inc.; Jeff Gordon Children’s Foundation; The Leukemia & Lymphoma Society; Medac, GmbH; MedImmune; The Medical College of Wisconsin; *Merck & Co, Inc.; Mesoblast; MesoScale Diagnostics, Inc.; *Miltenyi Biotec, Inc.; National Marrow Donor Program; Neovii Biotech NA, Inc.; Novartis Pharmaceuticals Corporation; Onyx Pharmaceuticals; Optum Healthcare Solutions, Inc.; Otsuka America Pharmaceutical, Inc.; Otsuka Pharmaceutical Co, Ltd. – Japan; PCORI; Perkin Elmer, Inc.; Pfizer, Inc; *Sanofi USA; *Seattle Genetics; *Spectrum Pharmaceuticals, Inc.; St. Baldrick’s Foundation; *Sunesis Pharmaceuticals, Inc.; Swedish Orphan Biovitrum, Inc.; Takeda Oncology; Telomere Diagnostics, Inc.; University of Minnesota; and *Wellpoint, Inc. The views expressed in this article do not reflect the official policy or position of the National Institute of Health, the Department of the Navy, the Department of Defense, Health Resources and Services Administration (HRSA) or any other agency of the US Government *Corporate Members.

Author contributions

Conception and design: Anuj Mahindra, Parameswaran Hari, Raphael Fraser, Anita D’Souza. Collection and assembly of data: Anuj Mahindra, Parameswaran Hari, Raphael Fraser, Mingwei Fei, Anita D’Souza. Data analysis and interpretation: All authors. Manuscript writing: All authors. Final approval: All authors.

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Authors and Affiliations

  1. University of California San Francisco Medical Center, San Francisco, CA, USA

    A Mahindra

  2. Department of Medicine, CIBMTR (Center for International Blood and Marrow Transplant Research), Medical College of Wisconsin, Milwaukee, WI, USA

    P Hari, R Fraser, M Fei, J Huang & A D’Souza

  3. Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA

    R Fraser

  4. Sarah Cannon BMT Program, Nashville, TN, USA

    J Berdeja

  5. University of Wisconsin Carbone Cancer Center, Madison, WI, USA

    N Callander

  6. Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA

    L Costa

  7. Department of Hematology/Oncology, Hospital Infantil Universitario Nino Jesus, Madrid, Spain

    M A Diaz

  8. Texas Transplant Institute, San Antonio, TX, USA

    C Freytes

  9. Division of Experimental Medicine, Department of Medicine, Hematology Research Centre, Imperial College London, London, UK

    R P Gale

  10. University of Cincinnati, Cincinnati, OH, USA

    S Girnius

  11. Fred Hutchinson Cancer Research Center, Nashville, TN, USA

    L Holmberg

  12. Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA

    M Kharfan-Dabaja

  13. Mayo Clinic Rochester, Rochester, MN, USA

    S Kumar & R Kyle

  14. Seidman Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA

    H Lazarus

  15. Royal Adelaide Hospital, Adelaide, SA, Australia

    C Lee

  16. Hospital Universitario Clementinio Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil,

    A Maiolino

  17. Division of Hematology & Oncology, Department of Medicine, Shands HealthCare & University of Florida, Gainesville, FL, USA

    J Moreb

  18. Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA

    T Nishihori

  19. Division of Hematology/Oncology, Department of Internal Medicine, Blood and Marrow Transplantation Program, The University of Michigan Medical School, Ann Arbor, MI, USA

    A Pawarode

  20. Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA

    A Saad

  21. Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA

    B N Savani

  22. Cancer Transplant Institute, Virginia G. Piper Cancer Center, Scottsdale, AZ, USA

    J Schriber

  23. Arizona Oncology, Scottsdale, AZ, USA

    J Schriber

  24. Ohio State Medical Center, Columbus, OH, USA

    B William

  25. Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, WA, USA

    B M Wirk

  26. City of Hope National medical Center, Duarte, CA, USA

    A Krishnan

  27. Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA

    Y Nieto

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  1. A Mahindra
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  2. P Hari
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  9. M A Diaz
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  10. C Freytes
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  11. R P Gale
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  12. S Girnius
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  14. M Kharfan-Dabaja
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  15. S Kumar
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  16. R Kyle
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  17. H Lazarus
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  18. C Lee
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  19. A Maiolino
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  20. J Moreb
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  23. A Saad
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  24. B N Savani
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  26. B William
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  28. A Krishnan
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  29. Y Nieto
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  30. A D’Souza
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Corresponding author

Correspondence to A D’Souza.

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The authors declare no conflict of interest.

Additional information

This work was presented in part as an oral presentation at the 59th Annual Meeting of the American Society of Hematology, San Diego, December 2016.

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Mahindra, A., Hari, P., Fraser, R. et al. Autologous hematopoietic cell transplantation for multiple myeloma patients with renal insufficiency: a center for international blood and marrow transplant research analysis. Bone Marrow Transplant 52, 1616–1622 (2017). https://doi.org/10.1038/bmt.2017.198

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