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

Abstract

Multiple myeloma (MM) is often associated with renal insufficiency (RI) which adversely influences the prognosis. Several studies demonstrated that bortezomib can improve both renal function and outcome. We prospectively evaluated 21 newly diagnosed MM patients with severe renal impairment secondary to tubularinterstitial damage, most of them due to myeloma kidney, who were primarily treated with bortezomib-based therapy combined with high cut-off hemodialysis (HCOD). The median serum creatinine level at baseline was 6.44 mg dL 21 and calculated median estimated glomerular filtration rate (eGFR), according to Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) creatinine equation, was 8 mL/min/1.73 m 2 . Serum free light chain (sFLC) median concentration was 6,040 mg L 21. Post induction and best stringent complete response rates were 19 and 38%, respectively. Responses were fast, occurring within a median of 1.4 months. The combination of bortezomib and HCOD led to a prompt and remarkable (>90%) decrease in sFLC levels. Sixteen patients (76%) became dialysis independent within a median of 32 days. With a median follow up of 17.2 months, the 3-year PFS and OS were 76 and 67%, respectively. No early deaths were observed. This study demonstrates that incorporation of bortezomib into induction therapy combined with HCOD is a highly effective strategy in rescuing renal function and improving outcomes in patients with MM and RI.

Patients with multiple myeloma have excellent long‐term outcomes after recovery from dialysis‐dependent acute kidney injury

“…This study is in response to recent reports that indicate an increasing proportion of patients are recovering independent renal function following MM and severe dialysis‐dependent AKI . Zannetti et al .…”

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

“…Since the occurrence of toxicities does not result in worse survival in DD patients compared to NRF patients all efforts should be focused on minimising of toxicities or becoming dialysis independent before transplantation and proceed to auto‐PBSCT in a safer condition. Dialysis independence may be improved by introduction of bortezomib . After chemotherapy with bortezomib the dialysis‐independent was observed in 13%‐50% of patients .…”

The Singapore Myeloma Study Group Consensus Guidelines for the management of patients with multiple myeloma

“…(21) Small cohort studies reported sustained renal recovery and dialysis independence in 75% of patients with renal impairment who were placed on high cut-off dialysis. (22) However, larger-scale studies are required to provide conclusive guidelines on the use of plasmapheresis or high cut-off dialysis in MM patients with severe renal impairment.…”