5784 - N-terminal B-type natriuretic peptide (NT-proBNP) as an independed prognostic marker for patients with newly diagnosed multiple myeloma complicated by dialysis-dependent renal failure

Background

About 20-30% patients with newly diagnosed multiple myeloma (ND MM) experience damage to kidneys and in 2-4% of cases, hemodialysis is required. NT‐proBNP synthesize in atria and ventricles cardiomyocytes and excreted by the kidney. The purpose of this work was to analyze the predictive utility of NT-proBNP in patients with ND MM, complicated by severe dialysis-dependent renal failure (RF).

Methods

Between 10.2016 and 07.2017, 20 patients with ND MM and terminal RF enrolled in this prospective study. Exclusion criteria were diagnosed at AL-amyloidosis and a significant cardiac pathology. Samples for NT‐proBNP analysis were collected before antimyeloma chemotherapy and not earlier than 36 hours after hemodialysis. The ROC analysis determined the area under the error curve as 0.75 (0.52-0.97), and the cut-off point for the OS was an NT-proBNP concentration of 7036 pg/ml (sensitivity 79%; specificity 44%). According to these data, the patients were divided into two groups, depending on the NT-proBNP value less than (n = 9) or more than (n = 11) 7000 pg/ml for the subsequent analysis.

Results

The median age of the patients was 67 years (range, 63-76). Median of estimated glomerular filtration CKD-EPI rate was 4.0 (IQR 4.0-5.0) ml/min/1.73 m². The only difference between the groups was the volume of residual diuresis 1250 (550-2500) vs. 50.0 (37.5-1038) ml/day (P = 0.036). As induction therapies, 11 (55%) patients underwent a VCD regimen, 7 (35%) - VD), and 2 (10%) - VMP. The ASCT accomplished in 1 patient. The renal response was documented in 4 (25.0%) cases including one complete response. With a median follow-up of 17.3 months, the overall OS was 48.5±11.5%. The 18-month OS for comparison groups were 76.6±14.8% and 27.3±13.4% (P = 0.020), respectively. There were no causes of death due to cardiovascular complications.

Conclusions

According to our data, NT-proBNP > 7400 pg/ml are associated with the severity of kidney damage and the risk of non-cardiac mortality in ND MM patients.

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.