Clinical features and outcomes after auto-SCT in patients with multiple myeloma and renal impairment

Abstract

Background: Autologous stem cell transplantation (ASCT) has become the standard of care for eligible patients with newly diagnosed multiple myeloma (MM). Although, attaining best pre-transplant response is important for long-term disease control, early progressive disease after ASCT is not fully understood in a subset ofMMpatients. The aim of this study is was to evaluate risk factors and clinical features of patients with early progression of disease after ASCT. Methods: We retrospectively reviewed 330 patients diagnosed with MM based on the International Myeloma Working Group diagnostic criteria and underwent ASCT between October 1998 and February 2015. Patients who progressed within 12months after ASCT were classified as the study group.Univariate andmultivariate analyses were performed on the recognized baseline parameters, and treatment related factors were also evaluated.Results: Among 324 patients, 103 (32%) progressed within 12 months after stem cell transplantation. Multivariate logistic regression analyses revealed that azotemia (Cr 2.0mg/dL) (RR1⁄43.2) and non-hyperdiploidy (RR1⁄42.6) were independently associated with early progressive disease (P<0.05). During a median 2.8 years of follow-up, the median overall survival of patients who progressed within 12 months after ASCT was significant poor (29.1months, 95% CI, 22.3-35.9) compared to those who did not progress within 12 months (94.5months, 95% CI, 78.5-110.5, p < 0.001). Conclusions: Early progression of disease after ASCT is associated with a poor prognosis in MM patients. PreASCT response ( PR versus < PR) did not affect early disease progression after stem cell transplantation. Patients with nonhyperdiploidy and azotemia may experience a limited benefit from ASCT. Further tailored therapy is needed for these patients.