Renal failure in multiple myeloma: reversibility and impact on the prognosis

Abstract

The purpose of the present study was to analyse the importance and prognostic value of renal failure in multiple myeloma patients. The frequency and reversibility of renal failure in 775 multiple myeloma patients diagnosed between 1984-86 and 1990-92 in the Nordic countries were studied. Renal failure, defined as plasma creatinine > 130 micromol/l, was observed in 29% of the cases at the time of diagnosis. During the first year after diagnosis 58% achieved normalisation of p-creatinine, and this was achieved mainly during the first 3 months. Reversibility of renal failure was more frequently observed in patients with moderate renal failure, hypercalcaemia and low Bence-Jones protein excretion. In a multivariate analysis renal failure, high age, stage III disease and hypercalcaemia were independent prognostic factors for survival. Patients who needed dialysis had a poor prognosis, with a median survival of 3.5 months. A 12-months landmark analysis showed that reversibility of renal failure was a more important prognostic factor than response to chemotherapy. It is concluded that renal failure in multiple myeloma is reversible in about half the cases, and reversibility of renal failure improves long-term survival.

Reply. Kastritis E. et al. Reversibility of renal failure in newly diagnosed multiple myeloma patients treated with high dose dexamethasone containing regimes and the impact of novel agents. Haematologica 2007; 92:546 9

“…Knudsen et al also describe that the reversibility of renal failure was more frequently observed in patients with moderate renal failure, hypercalcaemia and low Bence-Jones protein excretion. 6 The observation of the authors that patients with light chain myeloma or BenceJones proteinuria had a lower probability of recovery of the renal failure is in accordance with this.…”

“…The conclusion of these data would be that it makes no difference, whether the renal failure would be treated or not. This is in contrast to the findings of Knudsen et al 6 in a study with 775 myeloma patients, who stated that renal failure in multiple myeloma is reversible in about half of the cases, and reversibility of renal failure improves long-term survival. In an other study it could be demonstrated that the transplant related mortality after stem cell transplantation is 0% in patients with normal renal function, 1% in patients with initial renal failure, who recoverd completely before stem cell transplantation and 17% in patients with renal failure, defined as creatinine clearance < 60 mL/min.…”

A pharmacokinetics and safety phase 1/1b study of oral ixazomib in patients with multiple myeloma and severe renal impairment or end‐stage renal disease requiring haemodialysis

“…Renal impairment (RI) is a frequent and severe complication of MM (Knudsen et al , 2000; Penfield, 2006). Depending on the threshold applied to define RI, up to half of patients with MM develop this condition (Clark et al , 1999; Tosi et al , 2015).…”

Renal allografts in plasma cell myeloma hematopoietic cell graft recipients: on the verge of an explosion?

“…[4][5][6][7] In early conventional chemotherapy trials, renal failure was found to be a predictor of poor prognosis. Presently, renal failure is considered to reflect a higher tumor burden with a lower median OS, in part reflecting that such patients may receive reduced doses of chemotherapy, have a higher treatment-related mortality or the combination.…”

“…Multiple retrospective studies demonstrate feasibility and potential efficacy even in the setting of hemodialysis. 3,7,15 The purpose of this article is to review the recent progress in the management of PCM patients with renal dysfunction, focusing especially on the feasibility of autologous HCT and renal transplant, including the assessment of suitability for renal allograft as a function of outcome after autologous HCT.…”