MM-324: Efficacy of Autologous Stem Cell Transplantation in Multiple Myeloma Patients with Renal Failure

• Published in: Clinical lymphoma, myeloma and leukemia Vol. 21; pp. S435 - S436
• Main Authors: Firsova, Maya, Mendeleeva, Larisa, Solovev, Maxim, Julhakyan, Hunan, Savchenko, Valeriy
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.09.2021
• Subjects: autologous stem cell transplantation; multiple myeloma; renal failure; renal response; MM; renal failure; renal response; multiple myeloma; autologous stem cell transplantation
• ISSN: 2152-2650; 2152-2669
• DOI: 10.1016/S2152-2650(21)01971-6

According to the Russian register, renal impairment at the time of diagnosis was noted in every fifth patient with multiple myeloma (MM). To study the efficacy and safety of high-dose therapy followed by ASCT in patients with MM and renal failure. A retrospective single-center study included 64 (30 males, 34 females) MM patients with renal failure aged 19 to 65 years (median 54) who underwent ASCT during a period from 2013 to 2019. At the time of diagnosis, median serum creatinine level was 462 pmol/L and median GFR was 10 ml/min/1.73 m2 (CKD-EPI). Twenty-three patients (36%) were dialysis-dependent at the time of diagnosis. Before ASCT, the OR rate was documented in 91% of cases. Renal response was achieved in 80% of patients. In 13 of 23 cases (57%), dialysis was stopped after induction therapy. Ten patients were dialysis-dependent at the time of ASCT. The analysis was carried out in subgroup A: patients without dialysis at the time of ASCT (n = 54) and subgroup B: dialysis-dependent patients at the time of ASCT (n = 10). In subgroup B patients compared to subgroup A patients, significant differences were observed in the requirement of red blood cell transfusions (100% vs 37%, p = 0.001). One hundred days after ASCT, the achievement of OR rate increased from 91 to 96%, and the percentage of CR increased from 45% to 64%. After auto-HSCT, there was an increase in the rate of achieving complete renal responses, from 28% to 34%. In one case, dialysis was stopped after the transplantation. So, at the time of diagnosis, 23 patients were dependent on renal replacement therapy. Because of induction therapy with auto-HSCT, 14 patients (61%) became hemodialysis-independent. Follow-up of these patients lasted from 1.5 to 7 years. There was no transplant-related mortality. After a median follow-up of 48 months, 5-year overall survival (OS) was 70%, and 5-year progression-free survival (PFS) was 42%. ASCT is a feasible, safe, and effective method of treatment in MM patients with severe kidney injury. In our study, 14 of 23 patients (61%) became dialysis-independent. Overall, this work confirmed dialysis-dependent MM patients should not be excluded from high-dose therapy followed by ASCT.