Real-world prognostic factors in autotransplanted multiple myeloma patients with severe renal impairment: study of the Polish Myeloma Study Group
Introduction The prognostic factors in autotransplanted multiple myeloma (MM) patients with concomitant advanced chronic kidney disease (CKD) are poorly understood, limited, and controversial. Material and methods We retrospectively analysed 44 patients with MM and CKD (eGFR < 40 ml/min), presen...
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Termedia Publishing House
2020-04-01
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| Series: | Archives of Medical Science |
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| author | Anna Waszczuk-Gajda David H. Vesole Jolanta Małyszko Artur Jurczyszyn Tomasz Wróbel Joanna Drozd-Sokołowska Piotr Boguradzki Krzysztof Mądry Agnieszka Tomaszewska Jarosław Biliński Maria Król Longin Niemczyk Magdalena Olszewska-Szopa Wieslaw W. Jedrzejczak Grzegorz W. Basak |
| author_facet | Anna Waszczuk-Gajda David H. Vesole Jolanta Małyszko Artur Jurczyszyn Tomasz Wróbel Joanna Drozd-Sokołowska Piotr Boguradzki Krzysztof Mądry Agnieszka Tomaszewska Jarosław Biliński Maria Król Longin Niemczyk Magdalena Olszewska-Szopa Wieslaw W. Jedrzejczak Grzegorz W. Basak |
| author_sort | Anna Waszczuk-Gajda |
| collection | DOAJ |
| description | Introduction
The prognostic factors in autotransplanted multiple myeloma (MM) patients with concomitant advanced chronic kidney disease (CKD) are poorly understood, limited, and controversial.
Material and methods
We retrospectively analysed 44 patients with MM and CKD (eGFR < 40 ml/min), present both at diagnosis and at autologous stem cell transplantation (ASCT), with no improvement of renal function in-between.
Results
Patients exhibiting deeper paraprotein responses to pre-transplant treatment predicted better response post ASCT (odds ratio (OR) = 11.6, p = 0.028) and longer progression-free survival (PFS) (hazard ratio (HR) = 0.23, p = 0.017). Higher albumin concentration (per increase of 1 g/dl) (HR = 0.41, p = 0.03) and melphalan 140 mg/m2 versus higher melphalan doses (HR = 0.86, p = 0.008) were associated with longer PFS. Performance status (ECOG 0-1 versus ≥ 2) (HR = 0.28, p = 0.0036), higher albumin concentration (HR = 0.43, p < 0.037), and melphalan 140 mg/m2 versus higher melphalan doses (HR = 0.48, p = 0.081) decreased the risk of death. Three of 32 dialysis-dependent patients became dialysis independent (DID), and 5 of 12 in the DID group had eGFR improvement post ASCT. The median PFS was 2.3 years, which was shorter for DID compared to DD patients (0.7 vs. 3.3 years, respectively). The median overall survival (OS) was 3.6 years, there was no difference in median OS between the groups (4.0 vs. 3.5 years, respectively).
Conclusions
Optimal patient selection including good performance status and higher albumin concentration (with every increase of 1 g/dl), chemotherapy-responsive disease pre-ASCT, melphalan dose adjusted to CKD, and intensive post-transplant supportive care are crucial to achieve acceptable results of treatment of MM patients with CKD. |
| format | Article |
| id | doaj-art-922f9b9bd4114184abe1018a2049c54a |
| institution | Kabale University |
| issn | 1734-1922 1896-9151 |
| language | English |
| publishDate | 2020-04-01 |
| publisher | Termedia Publishing House |
| record_format | Article |
| series | Archives of Medical Science |
| spelling | doaj-art-922f9b9bd4114184abe1018a2049c54a2025-01-27T10:45:12ZengTermedia Publishing HouseArchives of Medical Science1734-19221896-91512020-04-012061864187310.5114/aoms.2020.93442117784Real-world prognostic factors in autotransplanted multiple myeloma patients with severe renal impairment: study of the Polish Myeloma Study GroupAnna Waszczuk-Gajda0David H. Vesole1Jolanta Małyszko2Artur Jurczyszyn3Tomasz Wróbel4Joanna Drozd-Sokołowska5Piotr Boguradzki6Krzysztof Mądry7Agnieszka Tomaszewska8Jarosław Biliński9Maria Król10Longin Niemczyk11Magdalena Olszewska-Szopa12Wieslaw W. Jedrzejczak13Grzegorz W. Basak14Department of Haematology, Oncology, and Internal Medicine, Warsaw Medical University, Warsaw, PolandMyeloma Division, John Theurer Cancer Centre, Hackensack University Medical Centre, NJ, USADepartment of Nephrology, Dialysistherapy, and Internal Diseases, Medical University of Warsaw, Warsaw, PolandDepartment of Haematology, Jagiellonian University Medical College, Krakow, PolandDepartment and Clinic of Haematology, Blood Neoplasms, and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, PolandDepartment of Haematology, Oncology, and Internal Medicine, Warsaw Medical University, Warsaw, PolandDepartment of Haematology, Oncology, and Internal Medicine, Warsaw Medical University, Warsaw, PolandDepartment of Haematology, Oncology, and Internal Medicine, Warsaw Medical University, Warsaw, PolandDepartment of Haematology, Oncology, and Internal Medicine, Warsaw Medical University, Warsaw, PolandDepartment of Haematology, Oncology, and Internal Medicine, Warsaw Medical University, Warsaw, PolandDepartment of Haematology, Oncology, and Internal Medicine, Warsaw Medical University, Warsaw, PolandDepartment and Clinic of Haematology, Blood Neoplasms, and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, PolandDepartment and Clinic of Haematology, Blood Neoplasms, and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, PolandDepartment of Haematology, Oncology, and Internal Medicine, Warsaw Medical University, Warsaw, PolandDepartment of Haematology, Oncology, and Internal Medicine, Warsaw Medical University, Warsaw, PolandIntroduction The prognostic factors in autotransplanted multiple myeloma (MM) patients with concomitant advanced chronic kidney disease (CKD) are poorly understood, limited, and controversial. Material and methods We retrospectively analysed 44 patients with MM and CKD (eGFR < 40 ml/min), present both at diagnosis and at autologous stem cell transplantation (ASCT), with no improvement of renal function in-between. Results Patients exhibiting deeper paraprotein responses to pre-transplant treatment predicted better response post ASCT (odds ratio (OR) = 11.6, p = 0.028) and longer progression-free survival (PFS) (hazard ratio (HR) = 0.23, p = 0.017). Higher albumin concentration (per increase of 1 g/dl) (HR = 0.41, p = 0.03) and melphalan 140 mg/m2 versus higher melphalan doses (HR = 0.86, p = 0.008) were associated with longer PFS. Performance status (ECOG 0-1 versus ≥ 2) (HR = 0.28, p = 0.0036), higher albumin concentration (HR = 0.43, p < 0.037), and melphalan 140 mg/m2 versus higher melphalan doses (HR = 0.48, p = 0.081) decreased the risk of death. Three of 32 dialysis-dependent patients became dialysis independent (DID), and 5 of 12 in the DID group had eGFR improvement post ASCT. The median PFS was 2.3 years, which was shorter for DID compared to DD patients (0.7 vs. 3.3 years, respectively). The median overall survival (OS) was 3.6 years, there was no difference in median OS between the groups (4.0 vs. 3.5 years, respectively). Conclusions Optimal patient selection including good performance status and higher albumin concentration (with every increase of 1 g/dl), chemotherapy-responsive disease pre-ASCT, melphalan dose adjusted to CKD, and intensive post-transplant supportive care are crucial to achieve acceptable results of treatment of MM patients with CKD.https://www.archivesofmedicalscience.com/Real-world-prognostic-factors-in-autotransplanted-multiple-myeloma-patients-with,117784,0,2.htmlmultiple myelomaadvanced chronic kidney diseaseautologous stem cell transplantationdialysis |
| spellingShingle | Anna Waszczuk-Gajda David H. Vesole Jolanta Małyszko Artur Jurczyszyn Tomasz Wróbel Joanna Drozd-Sokołowska Piotr Boguradzki Krzysztof Mądry Agnieszka Tomaszewska Jarosław Biliński Maria Król Longin Niemczyk Magdalena Olszewska-Szopa Wieslaw W. Jedrzejczak Grzegorz W. Basak Real-world prognostic factors in autotransplanted multiple myeloma patients with severe renal impairment: study of the Polish Myeloma Study Group Archives of Medical Science multiple myeloma advanced chronic kidney disease autologous stem cell transplantation dialysis |
| title | Real-world prognostic factors in autotransplanted multiple myeloma patients with severe renal impairment: study of the Polish Myeloma Study Group |
| title_full | Real-world prognostic factors in autotransplanted multiple myeloma patients with severe renal impairment: study of the Polish Myeloma Study Group |
| title_fullStr | Real-world prognostic factors in autotransplanted multiple myeloma patients with severe renal impairment: study of the Polish Myeloma Study Group |
| title_full_unstemmed | Real-world prognostic factors in autotransplanted multiple myeloma patients with severe renal impairment: study of the Polish Myeloma Study Group |
| title_short | Real-world prognostic factors in autotransplanted multiple myeloma patients with severe renal impairment: study of the Polish Myeloma Study Group |
| title_sort | real world prognostic factors in autotransplanted multiple myeloma patients with severe renal impairment study of the polish myeloma study group |
| topic | multiple myeloma advanced chronic kidney disease autologous stem cell transplantation dialysis |
| url | https://www.archivesofmedicalscience.com/Real-world-prognostic-factors-in-autotransplanted-multiple-myeloma-patients-with,117784,0,2.html |
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