Abstract 789P
Background
Renal impairment (RI) is one of the most common complications of multiple myeloma (MM) and is associated with lower 3-year overall survival (OS). This study assess the renal response (RR) to treatment and survival in MM patients presenting with RI.
Methods
This was a prospective study conducted in the Department of Medical Oncology, Regional Cancer Centre Thiruvananthapuram. Newly diagnosed patients with MM and RI were included in the study. All patients received bortezomib-based treatment. The renal function was assessed before each treatment cycle to look for a RR. The RR and myeloma response were defined according to the criteria formulated by the IMWG.
Results
A total of 100 MM patients with RI were included, which constituted 24.1% of our total MM patients. The median age at presentation was 64 years with a male-to-female ratio of 2.3:1. The most common presenting symptom was pain in 73% patients. Majority of the patients had a ECOG PS of 2. At presentation anemia was reported in 67%, hypercalcemia in 27%, and lytic bone lesion in 95% of the patients. As per the CKD staging, stage 3b (35%), stage 4 (51%), and stage 5 (14%) of patients. Sixty-six patients had IgG subtype, 15% had IgA, 1% had IgD and 14% had light chain only. The light chains were of kappa subtype (62%), lambda subtype (38%). Fifty-eight patients were having ISS stage III disease, stage II (23%), and stage I (19%). The median number of cycles of bortezomib-based therapy was 6 cycles. At a median follow up of 24 months, 65% patients achieved CRenal, PRenal (6%), MRenal (16%). The best RR was achieved after a median of 2 cycles. The overall myeloma response rate was 73%. Sixty patients achieved good myeloma response with either complete response or very good partial response. Of the patients who achieved a good RR, 78.6% had a good myeloma response, while for those with poor RR only 19.2% achieved a good myeloma response. The median progression free survival of renal responders vs non responders (not reached(nr) vs 10 months, HR= 0.34) and median OS of renal responders vs non responders (nr vs 16 months, HR= 0.21) were statistically significant.
Conclusions
The timely institution of supportive care and antimyeloma treatment in patients with MM and RI leads to good RR and thereby better myeloma response.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.