Abstract
Renal impairment (RI) is seen in over a quarter of patients with newly diagnosed multiple myeloma (NDMM). It is not clear if reversal of RI improves the outcome to that expected for NDMM patients without RI. We evaluated 1135 consecutive patients with NDMM seen at the Mayo Clinic between January 2003 and December 2012. RI was defined as having a creatinine clearance (CrCl) <40ml/min. The median overall survival (OS) for patients with RI at diagnosis receiving and not receiving novel agent induction therapy was not reached vs 46 months (P<0.001). The median OS for patients with CrCl ⩾40 ml/min at diagnosis, CrCl <40 ml/min at diagnosis but improved to ⩾40 ml/min and CrCl <40 ml/min at diagnosis and remained <40 ml/min, were 112, 56 and 33 months, respectively (P<0.001). The complete renal response rate for patients with RI at diagnosis receiving novel agent induction therapy compared to the rest was 40 vs 16% (P<0.001). In conclusion, patients with reversal of RI have improved outcomes, but it remains inferior to patients with normal renal function at diagnosis. These results have implications for identifying early treatment strategies for patients at risk of developing renal insufficiency.
Highlights
Multiple myeloma (MM) is the second most common hematologic malignancy among adults in the United States.[1]
This study suggests that though Renal impairment (RI) in newly diagnosed MM (NDMM) patients is associated with a worse overall survival (OS) as Improvement in renal function and its relationship with early mortality
The current IMWG definition of MM-related RI requires a serum response in myeloma and this likely translates to higher rates of improvement in renal function.[29,30,31,32]
Summary
Multiple myeloma (MM) is the second most common hematologic malignancy among adults in the United States.[1]. The incorporation of novel therapeutic agents such as immunomodulators (thalidomide, lenalidomide and pomalidomide) and proteasome inhibitors (bortezomib and carfilzomib) as well as improved supportive care options have led to significant improvements in the OS of patients with MM.[12,13,14,15,16] These beneficial effects have been described in newly diagnosed MM patients with RI.[17,18,19] it has been shown that improvement in renal function can lead to improved survival in patients with MM,[19,20] it is not clear whether complete recovery of renal function improves survival outcomes to that experienced by MM patients who did not have RI at diagnosis We addressed this question in a large cohort of patients with NDMM seen over the last decade at a single institution.
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