About 2-4% of patients with newly diagnosed multiple myeloma (MM) present with severe dialysis required renal failure (RF), which is associated with significant morbidity and early death. The aim of this article was to analyze own experience in treating this category.
During 10.2014-12.2017 the sixty-two patients with severe RF with a glomerular filtration rate (eGFR) <30 ml/min/1.73m2 were enrolled in this retrospective study. All patients received bortezomib-based regimens: 41 (66.1%) VDC; 2 (3.2%) PAD; 12 (19.4%) VD and 7 (11.3%) VMP. Seven (11.3%) patients underwent high-dose therapy with ASCT. IMWG (2010) renal response criteria were used. Myeloma response was evaluated using the standard IMWG (2006) criteria.
At the time of presentation 48 (77%) patients required dialysis. The mean eGFR was 6.0 (95% CI 4.4-7.6) for patients requiring dialysis (Group A) and 22.2 (16.4-29.2) ml/min/1.73 m2 for those (Group B) are a dialysis independent (P < 0.001). Mean level of involved free light chain (iFLC) was 7400 (3440-10840) mg/l vs 2900 (780-5020) mg/l respectively (P < 0.001). The median time from RF to start of MM chemotherapy comprise 39 and 21 days for two groups respectively. Six (9.7%) patients died within the first 60 days of therapy (induction mortality). At least minimal renal response ( > =MRrenal) documented in 23.5% and 57.1% patients respectively. If the duration RF before initiation of MM treatment was >1 month no one patient required dialysis restored a renal function. Among all patients, overall myeloma response ( > =PR) documented in 81% cases, including 39.6% very good partial response (VGPR) and 14.6% complete response (CR/sCR). Two-years overall survival (OS) was 67.8 ± 6.4% without any different between groups.
In conclusion, our data indicate that bortezomib-based triplets are associated with a significant probability of renal response. In at least a 23.5% of patients with MM presenting with dialysis-requiring severe RF may improve their renal function and discontinue dialysis. Unfortunately, our results are inferior to the literature data according to which up to 50% of patients become independent of dialysis.
Clinical trial identification
Legal entity responsible for the study
Has not received any funding.
All authors have declared no conflicts of interest.