Abstract
Renal impairment is a common complication of multiple myeloma (MM), accounting for 20–30% of MM patients at diagnosis and 40–50% of patients during the course of their disease. This feature is associated with poor prognosis and shorter survival as compared to patients with normal renal function (NRF). Therefore, therapeutic management is challenging as autologous stem cell transplantation (ASCT) is often not considered as a valuable strategy, mainly due to concerns of toxicity. In this retrospective and multicenter study, we included 55 MM patients with dialysis-dependent or independent renal failure who underwent high-dose melphalan-based ASCT in order to assess the efficacy outcomes and toxicities of this strategy. Response to ASCT was at least VGPR (very good PR) in 58% of patients and 96% of patients who also received bortezomib-based induction were at least in PR after ASCT. Median OS was 76 months and median PFS was 55 months, similarly to MM patients with NRF. In multivariate analysis, dose of melphalan (140 mg/m2) was correlated with better PFS (18 months, P = 0.005). Toxicities included febrile neutropenia (75%) and severe mucositis (34%). Overall, this work confirmed that ASCT conditioned by 140 mg/m2 melphalan is a beneficial procedure for MM patients with renal failure.
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References
Dimopoulos MA, Sonneveld P, Leung N, Merlini G, Ludwig H, Kastritis E et al. International myeloma working group recommendations for the diagnosis and management of myeloma-related renal impairment. J Clin Oncol. 2016; https://doi.org/10.1200/JCO.2015.65.0044
Dimopoulos MA, Delimpasi S, Katodritou E, Vassou A, Kyrtsonis MC, Repousis P, et al. Significant improvement in the survival of patients with multiple myeloma presenting with severe renal impairment after the introduction of novel agents. Ann Oncol. 2014;25:195–200.
Zannetti BA, Zamagni E, Santostefano M, De Sanctis LB, Tacchetti P, Mancini E, et al. Bortezomib-based therapy combined with high cut-off hemodialysis is highly effective in newly diagnosed multiple myeloma patients with severe renal impairment. Am J Hematol. 2015;90:647–52.
Attal M, Lauwers-Cances V, Hulin C, Leleu X, Caillot D, Escoffre M, et al. Lenalidomide, bortezomib, and dexamethasone with transplantation for myeloma. N Engl J Med. 2017;376:1311–20.
Badros A, Barlogie B, Siegel E, Roberts J, Langmaid C, Zangari M, et al. Results of autologous stem cell transplant in multiple myeloma patients with renal failure. Br J Haematol. 2001;114:822–9.
Ballester OF, Tummala R, Janssen WE, Fields KK, Hiemenz JW, Goldstein SC, et al. High-dose chemotherapy and autologous peripheral blood stem cell transplantation in patients with multiple myeloma and renal insufficiency. Bone Marrow Transplant. 1997;20:653–6.
Bird JM, Fuge R, Sirohi B, Apperley JF, Hunter A, Snowden J, et al. The clinical outcome and toxicity of high-dose chemotherapy and autologous stem cell transplantation in patients with myeloma or amyloid and severe renal impairment: a british society of blood and marrow transplantation study. Br J Haematol. 2006;134:385–90.
El Fakih R, Fox P, Popat U, Nieto Y, Shah N, Parmar S, et al. Autologous hematopoietic stem cell transplantation in dialysis-dependent myeloma patients. Clin Lymphoma Myeloma Leuk. 2015;15:472–6.
Gertz MA, Lacy MQ, Dispenzieri A, Hayman SR, Kumar S, Leung N, et al. Impact of age and serum creatinine value on outcome after autologous blood stem cell transplantation for patients with multiple myeloma. Bone Marrow Transplant. 2007;39:605–11.
Glavey SV, Gertz MA, Dispenzieri A, Kumar S, Buadi F, Lacy M, et al. Long-term outcome of patients with multiple [corrected] myeloma-related advanced renal failure following auto-SCT. Bone Marrow Transplant. 2013;48:1543–7.
Knudsen LM, Nielsen B, Gimsing P, Geisler C. Autologous stem cell transplantation in multiple myeloma: outcome in patients with renal failure. Eur J Haematol. 2005;75:27–33.
Lee CK, Zangari M, Barlogie B, Fassas A, van Rhee F, Thertulien R, et al. Dialysis-dependent renal failure in patients with myeloma can be reversed by high-dose myeloablative therapy and autotransplant. Bone Marrow Transplant. 2004;33:823–8.
Parikh GC, Amjad AI, Saliba RM, Kazmi SMA, Khan ZU, Lahoti A, et al. Autologous hematopoietic stem cell transplantation may reverse renal failure in patients with multiple myeloma. Biol Blood Marrow Transplant. 2009;15:812–6.
Raab MS, Breitkreutz I, Hundemer M, Benner A, Klaus J, Hegenbart U, et al. The outcome of autologous stem cell transplantation in patients with plasma cell disorders and dialysis-dependent renal failure. Haematologica. 2006;91:1555–8.
San Miguel JF, Lahuerta JJ, García-Sanz R, Alegre A, Bladé J, Martinez R, et al. Are myeloma patients with renal failure candidates for autologous stem cell transplantation? Hematol J. 2000;1:28–36.
St Bernard R, Chodirker L, Masih-Khan E, Jiang H, Franke N, Kukreti V, et al. Efficacy, toxicity and mortality of autologous sct in multiple myeloma patients with dialysis-dependent renal failure. Bone Marrow Transplant. 2015;50:95–99.
Sweiss K, Patel S, Culos K, Oh A, Rondelli D, Patel P. Melphalan 200 Mg/m2 in patients with renal impairment is associated with increased short-term toxicity but improved response and longer treatment-free survival. Bone Marrow Transplant. 2016;51:1337–41.
Durie BG, Harousseau JL, Miguel JS, Bladé J, Barlogie B, Anderson K, et al. International uniform response criteria for multiple myeloma. Leukemia. 2006;20:1467–73.
Moreau P, Attal M, Pégourié B, Planche L, Hulin C, Facon T, et al. Achievement of VGPR to induction therapy is an important prognostic factor for longer PFS in the IFM 2005-01 trial. Blood. 2011;117:3041–4.
Harousseau JL, Attal M, Avet-Loiseau H, Marit G, Caillot D, Mohty M, et al. Bortezomib plus dexamethasone is superior to vincristine plus doxorubicin plus dexamethasone as induction treatment prior to autologous stem-cell transplantation in newly diagnosed multiple myeloma: results of the IFM 2005-01 phase III trial. J Clin Oncol. 2010;28:4621–9.
Breitkreutz I, Heiss C, Perne A, Beimler J, Jäger D, Egerer G, et al. Bortezomib improves outcome after SCT in multiple myeloma patients with end-stage renal failure. Bone Marrow Transplant. 2014;49:1371–5.
Scheid C, Sonneveld P, Schmidt-Wolf IGH, van der Holt B, el Jarari L, Bertsch U, et al. Bortezomib before and after autologous stem cell transplantation overcomes the negative prognostic impact of renal impairment in newly diagnosed multiple myeloma: a subgroup analysis from the HOVON-65/GMMG-HD4 trial. Haematologica. 2014;99:148–54.
Dimopoulos MA, Roussou M, Gkotzamanidou M, Nikitas N, Psimenou E, Mparmparoussi D, et al. The role of novel agents on the reversibility of renal impairment in newly diagnosed symptomatic patients with multiple myeloma. Leukemia. 2013;27:423–9.
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Augeul-Meunier, K., Chretien, ML., Stoppa, AM. et al. Extending autologous transplantation as first line therapy in multiple myeloma patients with severe renal impairment: a retrospective study by the SFGM-TC. Bone Marrow Transplant 53, 749–755 (2018). https://doi.org/10.1038/s41409-018-0122-8
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DOI: https://doi.org/10.1038/s41409-018-0122-8
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