Improvement in renal function and its impact on survival in patients with newly diagnosed multiple myeloma

• Published in: Blood cancer journal (New York) Vol. 5; no. 3; p. e296
• Main Authors: Gonsalves, W I, Leung, N, Rajkumar, S V, Dispenzieri, A, Lacy, M Q, Hayman, S R, Buadi, F K, Dingli, D, Kapoor, P, Go, R S, Lin, Y, Russell, S J, Lust, J A, Zeldenrust, S, Kyle, R A, Gertz, M A, Kumar, S K
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 20.03.2015; Springer Nature B.V; Nature Publishing Group
• Subjects: 631/67/1990/804; 692/699/67/1059/99; Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Biomedical and Life Sciences; Biomedicine; Cancer Research; Cytogenetics; Female; Glomerular Filtration Rate; Hematology; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Multiple Myeloma - blood; Multiple Myeloma - complications; Multiple Myeloma - drug therapy; Multiple Myeloma - pathology; Neoadjuvant Therapy; Neoplasm Staging; Oncology; Original; original-article; Renal Insufficiency - blood; Renal Insufficiency - complications; Renal Insufficiency - drug therapy; Renal Insufficiency - epidemiology; Renal Insufficiency - pathology; Treatment Outcome
• ISSN: 2044-5385; 2044-5385
• DOI: 10.1038/bcj.2015.20

Renal impairment (RI) is seen in over a quarter of patients with newly diagnosed multiple myeloma (NDMM). It is not clear if reversal of RI improves the outcome to that expected for NDMM patients without RI. We evaluated 1135 consecutive patients with NDMM seen at the Mayo Clinic between January 2003 and December 2012. RI was defined as having a creatinine clearance (CrCl) <40ml/min. The median overall survival (OS) for patients with RI at diagnosis receiving and not receiving novel agent induction therapy was not reached vs 46 months ( P <0.001). The median OS for patients with CrCl ⩾40 ml/min at diagnosis, CrCl <40 ml/min at diagnosis but improved to ⩾40 ml/min and CrCl <40 ml/min at diagnosis and remained <40 ml/min, were 112, 56 and 33 months, respectively ( P <0.001). The complete renal response rate for patients with RI at diagnosis receiving novel agent induction therapy compared to the rest was 40 vs 16% ( P <0.001). In conclusion, patients with reversal of RI have improved outcomes, but it remains inferior to patients with normal renal function at diagnosis. These results have implications for identifying early treatment strategies for patients at risk of developing renal insufficiency.