The role of novel agents on the reversibility of renal impairment in newly diagnosed symptomatic patients with multiple myeloma

Abstract

The role of thalidomide, bortezomib and lenalidomide in multiple myeloma patients presenting with renal impairment was evaluated in 133 consecutive newly diagnosed patients who were treated with a novel agent-based regimen. A significant improvement of renal function (XrenalPR (renal partial response)) was observed in 77% of patients treated with bortezomib, in 55% with thalidomide and in 43% with lenalidomide (P ¼ 0.011). In multivariate analysis, bortezomib-based therapy was independently associated with a higher probability of renal response compared with thalidomide-or lenalidomide-based therapy. Other important variables included eGFR (estimated glomerular filtration rate) X30 ml/min, age p65 years and myeloma response. Patients treated with bortezomib achieved at least renalPR in a median of 1.34 months vs 2.7 months for thalidomide and 46 months for lenalidomide-treated patients (P ¼ 0.028). In multivariate analysis bortezomib-based therapy, higher doses of dexamethasone (X160 mg during the first month of treatment), an eGFR X30 ml/min and age p65 years were independently associated with shorter time to renal response. In conclusion, bortezomib-based therapies may be more appropriate for the initial management of patients with myeloma-related renal failure; however, thalidomide and lenalidomide are also associated with significant probability of improvement of their renal function.

Bortezomib‐based therapy combined with high cut‐off hemodialysis is highly effective in newly diagnosed multiple myeloma patients with severe renal impairment

“…The role of the novel agents thalidomide, bortezomib and lenalidomide in the management of MM patients presenting with RI was recently evaluated [23]. A significant improvement in renal function (PR renal ) was observed in 77, 55, and 43% of patients treated with bortezomib, thalidomide and lenalidomide, respectively.…”

Limiting early mortality: Do's and don'ts in the management of patients with newly diagnosed multiple myeloma

“…Similarly, the analysis of a cohort of patients with glomerular filtration rate <50 mL/min entering the VISTA trial revealed 44% of renal responses in the VMP arm vs. 34% in the MP arm [25]. Many other series demonstrated partial or complete reversal of renal impairment with bortezomib or bortezomibcontaining regimens [26][27][28][29][30]. Retrospective data are also available demonstrating reversibility of RI in regimens containing immunomodulatory drugs [31].…”

Phase 1 study of weekly dosing with the investigational oral proteasome inhibitor ixazomib in relapsed/refractory multiple myeloma

“…[11][12][13][14][15]20 In particular, bortezomib plays a critical role in the management of patients with genetically high-risk MM 14,[21][22][23] and patients with renal insufficiency. 24,25 The introduction of subcutaneous administration has improved convenience compared with the intravenous approach and substantially reduced the risk of peripheral neuropathy (PN), 26 a major limiting factor for long-term administration. 27 Other studies have shown that once-weekly administration of bortezomib can significantly reduce the risk of PN while preserving efficacy.…”