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Bortezomib‐based triplets are associated with a high probability of dialysis independence and rapid renal recovery in newly diagnosed myeloma patients with severe renal failure or those requiring dialysis
Author(s) -
Dimopoulos Meletios A.,
Roussou Maria,
Gavriatopoulou Maria,
Psimenou Erasmia,
EleutherakisPapaiakovou Evangelos,
Migkou Magdalini,
Matsouka Charis,
Mparmparousi Despoina,
Gika Dimitra,
Kafantari Eftychia,
Ziogas Dimitrios,
Fotiou Despoina,
Panagiotidis Ioannis,
Terpos Evangelos,
Kastritis Efstathios
Publication year - 2016
Publication title -
american journal of hematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.456
H-Index - 105
eISSN - 1096-8652
pISSN - 0361-8609
DOI - 10.1002/ajh.24335
Subject(s) - medicine , dialysis , discontinuation , bortezomib , multiple myeloma , surgery
Renal failure (RF) is a common and severe complication of symptomatic myeloma, associated with significant morbidity and mortality. Such patients are commonly excluded from clinical trials. Bortezomib/dexamethasone (VD)‐based regimens are the backbone of the treatment of newly diagnosed MM patients who present with severe RF even those requiring dialysis. We analyzed the outcomes of 83 consecutive bortezomib‐treated patients with severe RF (eGFR < 30 ml/min/1.73 m 2 ), of which 31 (37%) required dialysis. By IMWG renal response criteria, 54 (65%) patients achieved at least MRrenal, including CRrenal in 35% and PRrenal in 12%. Triplet combinations (i.e., VD plus a third agent) versus VD alone were associated with higher rates of renal responses (72 vs. 50%; P = 0.06). Fifteen of the 31 (48%) patients became dialysis independent within a median of 217 days (range 11–724). Triplets were associated with a higher probability of dialysis discontinuation (57 vs. 35%). Serum free light chain (sFLC) level ≥11,550 mg/L was associated with lower rates of major renal response, longer time to major renal response, lower probability, and longer time to dialysis discontinuation. Rapid myeloma response (≥PR within the first month) was also associated with higher rates of renal response. Patients who became dialysis‐independent had longer survival than those remaining on dialysis. In conclusion, VD‐based triplets are associated with a significant probability of renal response and dialysis discontinuation, improving the survival of patients who became dialysis independent. Rapid disease response is important for renal recovery and sFLCs are predictive of the probability and of the time required for renal response. Am. J. Hematol. 91:499–502, 2016. © 2016 Wiley Periodicals, Inc.