PS1433 RESULTS OF AUTOLOGOUS STEM CELL TRANSPLANTATION IN MULTIPLE MYELOMA PATIENTS WITH RENAL FAILURE

Abstract

Background:Multiple Myeloma (MM) is a hematological malignancy in which renal involvement is common. Almost half of MM patients have increased creatinine levels at the time of diagnosis. In 20% of these patients, creatinine level is above 2 mg/dl. Kidney damage can be reversible in 50% of these patients.Aims:In this retrospective study, we evaluated the outcomes of autologous stem cell transplantation (ASCT) which was done in our center in multiple myeloma patients with renal failure. We compared the outcomes of these patients with patients with normal renal functions and who underwent ASCT. In patients with renal failure, melphalan 140 mg/m2 was used as conditioning regimen.Methods:We retrospectively analyzed the files of 574 patients with multiple myeloma in our center. We identified 106 patients who had ASCT between 2007–2018. We calculated creatinine clearances (CrCl) with Modification of Diet in Renal Disease (MDRD) formula at diagnosis. Patients were divided into 2 categories according to their CrCl results: patients with CrCl above 60 ml/min (n = 41), patients with CrCl below 60 ml/min (n = 28).Demographic data, laboratory results, pre‐transplant treatment and response to treatments were presented in Table 1.Results:Median follow‐up of the patients was 54 months. Median progression‐free survival (PFS) in patients with CrCl<60 ml/min and ≥60 ml/min was 56 months and 62 months, respectively. Three‐year PFS in these patients was 56.4% and 58%, respectively (p = 0.859). Median overall survival in patiens CrCl<60 ml/min was 69 months; median OS was not reached in patients with CrCl≥60 ml/min (p = 0.001). Median OS of all patients was 90 months. Four‐year OS of patients with CrCl<60 ml/min and≥ 60 ml/min was 69.9% vs. 97%, respectively (p = 0.001).We found that patients who had an improvement after ASCT in their renal functions had a better OS than compared to patients who had no improvement after ASCT (49 vs 73 months, respectively, p = 0.095). Four of the 7 patients with dialysis‐dependent renal failure at the time of diagnosis became dialysis independent. Median creatinine clearences of patients with CrCl <60 ml/min before and after ASCT was 25.45 ml/min and 54.39 ml/min respectively. CrCl increased above 60 ml/min in 11 patients. CrCl increased %50 above baseline in 18 patients.Summary/Conclusion:In conclusion treatment response rates and progression‐free survival rates were not affected by renal failure. Treatment of patients with renal insufficiency should not be different than those of patients who do not have renal failure. Standard myeloma treatment and ASCT should be used in these patients; melphalan dose can be reduced to 140 mg/m2 in patients with CrCl <60 ml/min.image