Outcomes of Myeloma Patients on Hemodialysis in the Era of Novel Therapies: An Analysis of the US Renal Data System

Abstract

Abstract 1803 Background.Historically, severe renal failure requiring hemodialysis (HD) complicates multiple myeloma (MM) in 2–13% of patients. Recent epidemiologic studies show marked improvements in the survival of MM in the era of autologous transplantation and novel agents (post-1995). It is not clear how these therapies, which are feasible on HD, have affected the outcome of MM patients on HD. We have performed the first study of outcomes of MM patients on HD treated during the era of novel therapies. Methods. Patients who were initiated on dialysis whose primary cause of ESRD was listed as MM between 1989–2008 were included using the US Renal Data System (USRDS) database, which incorporates extensive baseline and follow-up demographic and clinical data on all patients accessing the Medicare ESRD program in the United States. The patients were divided into three time periods based on the introduction of novel therapies: 1989–1994, 1995–2000 and 2001–2008. Survival was calculated using dates of dialysis initiation, death, or end of study period and compared using Cox regression analysis. Results. The characteristics of the patients are shown in the table. After 1995 MM patients initiated on HD were older, had significantly more co-morbidities, poorer functional status and a lower albumin. The patients in 1989–1994 had markedly lower rates of co-morbidities than the general USRDS population. The median survival was 1.77, 0.74 and 0.69 years (p<0.0001) in 198994, 1995–2000, and 2001–2008, respectively. The rates of survival at 1 and 5 years were significantly lower in the two latter time periods. Adjusting for age, hemoglobin, albumin, and co-morbidities, the latter time periods were associated with a HR for death of 3.21 [95% CI 2.18–4.73, p<0.001] and 3.22 [2.18-4.74, p <0.001)], respectively. Conclusions. Patients with MM initiated on HD in the era of novel therapies have significantly more co-morbidities and worse survival. Given the effectiveness of novel therapies, it is likely that MM patients requiring HD in the era of novel therapies represent a population with aggressive, treatment refractory disease for whom alternative approaches are needed. An analysis of therapies delivered to this population is planned.1989–19941995–20002001–2008pN (% of total)161 (1.1)4780 (33.5)9321 (65.4)% of total ESRD0.40.91.1<0.001Age64.18 ± 11.9267.42 ± 11.4667.94 ± 11.54<0.001*AA Race24 (14.9)1037 (21.7)1974 (21.2)0.108Male Gender104 (64.6)2690 (56.3)5143 (55.2)0.033DM5 (3.1)542 (11.3)1596 (17.1)<0.001HTN26 (16.1)2126 (44.5)5518 (59.2)<0.001CHF14 (8.7)786 (16.4)1473 (15.8)0.025COPD1 (0.6)235 (4.9)547 (5.9)0.002CAD7 (4.3)598 (12.5)1301 (14.0)<0.001PVD4 (2.5)178 (3.7)436 (4.7)0.016CVA2 (1.2)180 (3.8)405 (4.3)0.047Nonambulatory2 (1.2)171 (3.6)432 (4.6)0.002Unable to transfer2 (1.2)60 (1.3)178 (1.9)0.015Hemoglobin (g/dl)9.46 ± 1.359.25 ± 1.729.53 ± 1.60<0.001**Albumin (g/dl)3.18 ± 0.643.08 ± 0.723.02 ± 0.74<0.001**1 yr survival104 (64.6)2008 (42.0)3758 (40.3)<0.0015 yr survival41 (25.5)408 (8.5)379 (4.1)<0.001Median survival1.77 [0.62–5.08]0.74 [0.27–2.00]0.69 [0.25–1.76]<0.001**Data presented as N(%), mean ± SD, median [interquartile range].*one-way ANOVA;**Kruskal Wallis test (Chi-square test for all others). Disclosures:No relevant conflicts of interest to declare.