Severe renal impairment as an adverse prognostic factor for survival in newly diagnosed multiple myeloma patients

Abstract

Background Renal impairment (RI) is associated with poor survival in newly diagnosed multiple myeloma (MM) patients. Renal function recovery has been one of the main therapeutic goals in those patients. Methods The records from 393 newly diagnosed MM patients in our hospital between January 2012 and December 2016 were retrospectively analyzed. RI was defined as an eGFR < 40 mL/min according to the novel IMWG criteria. RI patients were categorized based on their renal function at diagnosis: severe RI: eGFR < 30 mL/min, and mild RI: 30 mL/min ≤ eGFR <40 mL/min. We explored whether RI, and particularly severe RI, was an adverse prognostic factor for survival, and investigated the impact of renal function recovery on survival. Results Severe RI, hemoglobin <100 g/L, LDH ≥ 245 U/L, hyperuricemia, 1q21 amplification, and lack of novel agent treatment were associated with decreased overall survival (OS). Severe RI patients with renal response had a median OS of 27 months compared with 18 months for those patients without renal response (P = .030), but their median OS was still significantly lower than that for patients without severe RI, which was 51 months. In severe RI patients, the overall renal response rate in bortezomib‐based regimens was significantly higher than that in nonbortezomib‐based regimens. Conclusion Our results suggest that severe RI is an adverse prognostic factor for survival in newly diagnosed MM patients, restoration of renal function may improve survival, and bortezomib‐based regimens may be the preferred treatment in patients with severe RI.

Difficult‐to‐treat patients with relapsed/refractory multiple myeloma: A review of clinical trial results

“…RI and worsening renal function is a known high-risk factor for both NDMM and RRMM that is associated with poor OS [55,56]. Between 20% and 50% of patients have RI at diagnosis, which may be caused by cast nephropathy, light chain deposition disease, AL amyloidosis, and hypercalcaemia [55,57].…”

Stratification for RRMM and Risk-Adapted Therapy: Sequencing of Therapies in RRMM

“…The median OS of patients with an eGFR ≥ 40 mL/min is about 51 months compared to only 17 months in patients with an eGFR < 40 mL/min. Achieving renal response is associated with improved survival [ 80 , 81 ]. Renal response occurs when renal impairment is reversed by treatment.…”

An overview of treatment options for patients with relapsed/refractory multiple myeloma and renal impairment

“…Studies have shown that RI is associated with reduced overall survival (OS) and increased risk of early mortality in MM, 5 , 10 , 11 with some suggesting a correlation between outcomes and degree of estimated glomerular filtration rate (eGFR) decline. 4 , 10 A recent meta-analysis 12 of six randomized controlled trials conducted through 2019 found that RI conferred a higher relative risk of disease progression or death among participants. Improvements in both OS and renal function have been reported with novel treatments for RRMM, particularly when compared to conventional chemotherapy.…”

“…Improvements in both OS and renal function have been reported with novel treatments for RRMM, particularly when compared to conventional chemotherapy. 10 Though improvement in renal function is associated with improved survival, OS remains inferior among patients with baseline RI compared to those with no RI at MM diagnosis. 10 , 11 …”

“… 10 Though improvement in renal function is associated with improved survival, OS remains inferior among patients with baseline RI compared to those with no RI at MM diagnosis. 10 , 11 …”