Elsevier

Leukemia Research

Volume 34, Issue 10, October 2010, Pages 1395-1397
Leukemia Research

Brief communication
Reversibility of renal failure in newly diagnosed patients with multiple myeloma and the role of novel agents

https://doi.org/10.1016/j.leukres.2010.04.024Get rights and content

Abstract

The purpose of this analysis was to assess the effect of novel agent-based regimens on the improvement of renal impairment (RI) in newly diagnosed patients with multiple myeloma. Ninety-six consecutive patients with RI received conventional chemotherapy (CC)-based regimens (n = 32), IMiDs-based regimens (n = 47) or bortezomib-based regimens (n = 17) as frontline therapy. Improvement of RI was more frequent in patients treated with novel agents (79% in IMiD- and 94% in bortezomib-treated groups versus 59% in CC-treated group; p = 0.02). Bortezomib-based regimens and CrCl > 30 ml/min at baseline independently correlated with a higher probability of at least renal partial response (PRrenal) and with a shorter time to PRrenal or better. Thus bortezomib-based regimens may be the preferred treatment for newly diagnosed myeloma patients with RI.

Introduction

Renal impairment (RI) is a common complication of multiple myeloma (MM). Depending on the definition of RI, this complication is reported in 20–40% of MM patients. About one-fifth of myeloma patients have a serum creatinine higher than 2 mg/dl at the time of diagnosis. Most patients have moderate renal failure with a serum creatinine lower than 4 mg/dl [1]. High-dose dexamethasone-based regimens have been extensively used for the initial management of MM patients presenting with RI [2]. Recently, novel agent-based regimens have been introduced in the frontline treatment of MM but their effect on the reversibility of RI and the potential predictive factors has not yet been fully clarified. The purpose of our analysis was to assess the effect of novel agent-based regimens on RI improvement and compare their efficacy with that of conventional chemotherapy (CC) and dexamethasone.

Section snippets

Patients and methods

Ninety-six consecutive, newly diagnosed, patients with MM and RI, who were treated over the last decade in our center, were evaluated. RI was defined as a sustained estimated creatinine clearance (CrCl) < 50 ml/min, calculated by the Cockroft–Gault formula, despite volume replacement and reversal of hypercalcemia. Patients were divided into three groups according to the type of frontline anti-myeloma treatment: group A included 32 patients who received CC plus dexamethasone (VAD, VAD-like

Results and discussion

The characteristics of the patients are shown in Table 1. The baseline median CrCl at the time of initiation of treatment was 27.1 ml/min (range: 3.9–49.3 ml/min); 55 (57%) patients had severe renal impairment defined as CrCl < 30 ml/min, including nine (9%) patients who required dialysis. Patients of group B were older than those of groups A and C (p = 0.003) while more patients in group C had light chain only MM (p = 0.014). No other differences were observed among the three groups.

Improvement of

Conflict of interest

Meletios A. Dimopoulos has received honoraria for participation in advisory boards of Celgene and Janssen-Cilag.

Acknowledgements

The paper was presented as an oral presentation at ASH 2009 Annual Meeting in New Orleans (abstract no. 955). We thank the staff of the Hematology and Oncology Division of the Department of Clinical Therapeutics of Alexandra General Hospital, the referring physicians for their contribution and valuable discussion and above all, the participating patients and their families.

Contributions. MR, EK, ET and MAD designed research, performed research and analyzed data; MR and MAD wrote the paper; DC

References (8)

There are more references available in the full text version of this article.

Cited by (70)

  • Renal pharmacotherapy: Dosage adjustment of medications eliminated by the kidneys

    2021, Renal Pharmacotherapy: Dosage Adjustment of Medications Eliminated by the Kidneys
View all citing articles on Scopus
View full text