Renal insufficiency predicts worse prognosis in newly diagnosed IgD multiple myeloma patients

Abstract

ObjectiveIgD multiple myeloma (MM) is a rare type of MM, accounting for about 1%–2% of all MMs. IgD MM always causes kidney damage and even leads to renal failure, which is the most common complication. This study aimed to explore the risk factors of renal damage and prognosis of IgD MM patients.DesignFrom March 2018 to November 2021, 85 patients with IgD MM diagnosed for the first time at the First Affiliated Hospital of Zhengzhou University were included in this study. We collected information on clinical features and laboratory examinations. Patients were divided into the renal impairment (RI) (47/85) and non-renal impairment (no-RI) (38/85) groups. Binary logistic regression was used to explore risk factors of renal damage. The Chi-square test was used to analyze the difference in chemotherapy effect between the two groups. We also analyzed whether early dialysis was beneficial to acute renal failure (RF) in IgD MM patients. Finally, Kaplan-Meier was used to compare the survival of the two groups.ResultsIn IgD MM, 55.3% of patients had renal damage as a complication, of which up to 59.6% presented with acute renal failure as the first manifestation. Serum β2-microglobulin (β2-MG) was an independent risk factor for renal damage in IgD MM (p = 0.002), but cytogenetic analysis suggested that it had no effect on patients’ renal damage. There was also no significant difference in the effect of chemotherapy between the two groups (p = 0.255). In patients with acute renal failure, there was no significant difference between dialysis and no dialysis groups in the proportion of patients with improved renal function after treatment. The median overall survival (OS) of the RI group was significantly shorter than that of the no-RI group (p = 0.042). In the RI group, the median OS was 29 months, and in the no-RI group, the median OS was > 40 months.ConclusionElevated serum β2-MG is an independent risk factor for renal damage. Compared with the no-RI group, patients in the RI group had poorer prognosis and shorter median OS. For patients with acute renal failure as the first manifestation, the treatment of primary disease is more meaningful than dialysis.

Diagnosis of Immunoglobulin D myeloma with severe renal involvement ten years after a solitary plasmacytoma

“…IgD MM is a rare type of MM much more common in the Asian population (9,10). It currently develops at a younger age, predominantly males, with a median age of onset of 58 years (9,10).…”

“…Asthenia, weakness, pallor, and bone pain are the most early manifestations (7). The risk of renal damage in IgD MM is increasing and the patients with renal impairment tend to be younger (10). According to the litterature, renal failure is present in 20% to 40% of patients at the time of diagnosis (7) while primary kidney involvement and severe renal insu ciency are seen in only 15% to 20% of cases (4,11,12).…”

“…The mechanisms of renal injury can be either due to light chain cast nephropathy or through the direct toxicity caused by intracellular crystals (7,11). When present, renal failure predicts worse prognosis in newly diagnosed IgD MM patients (10).…”

Comparison of eGFR formulas (CKD-EPI and MDRD) in patients with multiple myeloma

“…With these results, it was observed that the gender distribution was slightly different from some studies 17-18-19 . The frequency of RF in those with MM changes between 20-50% depending on the description of RF 4,5 . In this study, we accepted the KD limit of 1.3 mg / dl and above and percentage of KD in MM patents was 45%.…”

“…Renal failure is a common complication of MM and is among the essential causes of mortality and morbidity. While it is seen in approximately 30% of patients at diagnosis this rate can be as high as 50% during the disease course [4][5] . Although it is generally moderate, approximately 10% of patients require renal replacement therapy 6 .…”