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Clin Lymphoma Myeloma Leuk. 2019 Aug;19(8):e415-e424. doi: 10.1016/j.clml.2019.05.010. Epub 2019 May 16.

Renal Impairment at Diagnosis in Myeloma: Patient Characteristics, Treatment, and Impact on Outcomes. Results From the Australia and New Zealand Myeloma and Related Diseases Registry.

Author information

1
Institute of Haematology, Royal Prince Alfred Hospital, Missenden Road, Camperdown, New South Wales, and University of Sydney, Sydney, Australia. Electronic address: joy.ho@sydney.edu.au.
2
School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
3
Department of Haematology, Alfred Health-Monash University, Melbourne, Victoria, Australia.
4
Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.
5
Middlemore Hospital, Middlemore, Auckland, New Zealand.
6
Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Melbourne, Australia.
7
Royal Adelaide Hospital, Adelaide, South Australia, Australia.
8
Institute of Haematology, Royal Prince Alfred Hospital, Missenden Road, Camperdown, New South Wales, and University of Sydney, Sydney, Australia; Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
9
Haematology Department, Princess Alexandra Hospital, Woolloongabba, Queensland, School of Medicine, University of Queensland, Brisbane, Australia.
10
University of Melbourne, St Vincent's Hospital, Victoria, Australia.
11
Myeloma Australia, Richmond, Victoria, Australia.

Abstract

BACKGROUND:

Renal impairment (RI) is a common complication of multiple myeloma (MM) and remains a poor prognostic factor despite improved survival with newer therapies.

PATIENTS AND METHODS:

We evaluated baseline characteristics, treatment, and outcomes of newly diagnosed MM patients with RI at diagnosis in the Australia and New Zealand Myeloma and Related Diseases Registry over 5 years to April 2018; we compared patients with RI (estimated glomerular filtration rate [eGFR] <60 mL/min/1.73 m2) with those with eGFR ≥60. In autologous stem cell transplantation (ASCT) analyses, patients aged 70 years and younger and ≥1 year from diagnosis were included.

RESULTS:

Overall, 36% of patients with newly diagnosed MM had RI; they were older, had more advanced disease and comorbidities, and worse performance status. Bortezomib-based induction therapy was most commonly used, although administered to fewer RI patients, despite similar response rates. Patients with RI were less likely to receive ASCT; however, recipients had longer progression-free survival (PFS) and overall survival (OS). Patients with RI had shorter OS and PFS after adjusting for age. In ASCT recipients with RI versus no RI, there was no difference in PFS and OS.

CONCLUSION:

Our findings in "real world" MM patients with RI confirm that patient-, disease-, and treatment-related factors (such as suboptimal bortezomib and ASCT use), and delays in commencing therapy, might contribute to poorer outcomes, and support the use of ASCT in patients with RI.

KEYWORDS:

Autologous; Multiple myeloma; Registry; Renal Impairment; Transplantation

PMID:
31208889
DOI:
10.1016/j.clml.2019.05.010

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