Autologous hematopoietic cell transplantation for multiple myeloma patients with renal insufficiency: a center for international blood and marrow transplant research analysis

Abstract

Autologous hematopoietic cell transplantation (AHCT) in multiple myeloma (MM) patients with renal insufficiency (RI) is controversial. Patients who underwent AHCT for MM between 2008-2013 were identified (N =1492) and grouped as normal/mild (≥60 ml/min), N=1240, moderate (30-59), N=185 and severe RI (<30), N=67 based on MDRD. Multivariate analysis of non-relapse mortality (NRM), relapse, progression-free survival (PFS) and overall survival (OS) was performed. Of the 67 patients with severe RI, 35 were on dialysis prior to AHCT. Patients received melphalan 200 mg/m2 (Mel200) in 92% (normal/mild), 75% (moderate) and 33% (severe) RI; remainder received 140 mg/m2 (Mel140). Thirty four of 35 patients with severe RI achieved post-AHCT dialysis independence. The 5-year PFS for normal, moderate and severe RI was 35 (95% CI, 31-38)%, 40 (31-49)% and 27 (15-40)% respectively, (p=0·42); 5-year OS for normal, mod and severe RI was 68 (65-71)%, 68 (60-76)% and 60 (46-74)% respectively, (p=0·69). With moderate RI, 5-year PFS for HDM 140 mg/m2 was 18 (6-35)% and for Mel200 was 46 (36-57)% (p=0·009). With severe RI, 5-year PFS Mel140 was 25 (11-41) % and for Mel200 was 32 (11-58)% (p=0·37). We conclude that AHCT is safe and effective in patients with MM with RI.

Autologous stem cell transplantation in the treatment of multiple myeloma patients with 17p deletion

“…This observation has been recently confirmed by Zagouri et al 29 Additionally, there are extensive literature data on kidney failure as a risk factor for MM and ASCT. [30][31][32][33] Our study confirms that ASCT has no benefit in MM. However, because of the limitation related to the retrospective design, this issue should be addressed in future prospective (possibly randomized) studies.…”

Autologous peripheral blood stem cell transplantation in dialysis‐dependent multiple myeloma patients—DAUTOS Study of the Polish Myeloma Study Group

“…Another consequence of increased toxicity in DD compared to NRF patients is transplant‐related mortality (8% vs 2%, P < .22) and prolonged hospitalisation (30 vs 21 days, P < .006) (Table ). Wide range of TRM rates from 0% to 15% were reported in DD patients . On the other hand, due to increased concentrations of melphalan and its antimyeloma effect, when patients overcome toxicity, one could expect a positive effect on the quality of response and prolongation of time to progression and death .…”

“…Wide range of TRM rates from 0% to 15% were reported in DD patients. 1,4,7,11,19,22 On the other hand, due to increased concentrations of melphalan and its antimyeloma effect, when patients overcome toxicity, one could expect a positive effect on the quality of response and prolongation of time to progression and death. 24,31,32 The positive effects in DD patients may result also from the correct qualification process by itself, because they are not dialysis-dependent multiple myeloma patients are treated with auto-PBSCT, but they are dialysis-dependent patients in whom due to generally good organ function (apart from renal failure) a low number of comorbidities, good performance status (in opposition to not eligible DD patients) and acceptablecompliance, the decision to undergo auto-PBSCT was made.…”

“…There are retrospective, inconsistent studies devoted to the safety and efficacy of auto-PBSCT procedure in DD patients. 4,[7][8][9][10][11][12][13] We aimed to provide characteristics of DD patients and to evaluate the outcomes of high dose therapy followed by auto-PBSCT in a real-life scenario of observational study and after propensity score matching with normal renal function MM patients (NRF).…”

Induction Therapy with Novel Agents and Autologous Stem Cell Transplant Overcomes the Adverse Impact of Renal Impairment in Multiple Myeloma

“…Other predictors of TRM included low serum albumin (p < 0.005), transplant post salvage for relapse (p < 0.05), and year of transplant, the TRM being higher in initial years compared to recently (p < 0.02) ( Table 4). A higher TRM has been reported in earlier studies ranging from 50% in dialysis-dependent severe RI (Knudson et al) [15,33], to 29% (San Miguel et al) [12], 18.5% (Bird et al) [13], 15% (St Bernard et al) [17], 14% (Gertz et al) [16], 12% (Lee et al) [14], 2.6% (Badros et al) [34], and 0% in a recent Center for International Blood and Marrow Transplant Research study [35]. A lower TRM in recent years is possibly due to the use of novel agents for induction leading to better depth of response thereby improving performance status at the time of transplant and also to better supportive care.…”