Bortezomib improves outcome after SCT in multiple myeloma patients with end-stage renal failure

Breitkreutz, Iris; Heiß, Christian; Perné, Andrea; Beimler, Jörg; Jäger, Dirk; Egerer, Gerlinde; Ho, A. D.; Neben, Kai; Zeier, Martin; Goldschmidt, Hartmut; Raab, Marc-Steffen

doi:10.1038/bmt.2014.165

Cited by 15 publications

(14 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…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 .…”

Section: Discussionmentioning

confidence: 99%

“…After chemotherapy with bortezomib the dialysis‐independent was observed in 13%‐50% of patients . Next, Breitkreuz et al found that bortezomib‐based therapy was associated with much better OS than non‐bortezomib based chemotherapy (83% vs 36%, P = .02) . But we should have to have in mind that some patients still remain dialysis‐dependent even after treatment with bortezomib.…”

Section: Discussionmentioning

confidence: 99%

“…Dialysis independence may be improved by introduction of bortezomib. 3,35,36 After chemotherapy with bortezomib the dialysis-independent was observed in 13%-50% of patients. [37][38][39] Next, Breitkreuz et al found that bortezomib-based therapy was associated with much better OS than non-bortezomib based chemotherapy (83% vs 36%, P = .02).…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

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

Waszczuk‐Gajda

Lewandowski

Drozd‐Sokołowska

et al. 2018

European J of Haematology

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

Waszczuk‐Gajda

Lewandowski

Drozd‐Sokołowska

et al. 2018

European J of Haematology

View full text Add to dashboard Cite

show abstract

“…Adverse event rate was comparable for each group for bortezomib; however, a higher frequency of adverse events and drug discontinuation was seen in the dexamethasone arm [59]. A number of other studies [37,38,40,50,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74] have reported on bortezomib in patients with RI; these are summarised in table 2.…”

Section: Treatment Of Myelomamentioning

confidence: 99%

Current Trends of Renal Impairment in Multiple Myeloma

2015

View full text Add to dashboard Cite

Background: Renal impairment (RI) is a common complication of multiple myeloma (MM). Around 50% of patients with MM have RI at presentation, and up to 5% require dialysis treatment. Severe acute kidney injury (AKI) as a cause of RI is a particular challenge as historically the survival of patients who sustain this complication and require dialysis is very poor. However, in this current period, survival is improving and the focus is on optimum use of novel chemotherapies and the evaluation of extra-corporeal therapies for removal of serum immunoglobulin light chains. Summary: RI in patients with MM is commonly associated with excess monoclonal free light chain (FLC) production; myeloma cast nephropathy is the predominant renal pathology in patients presenting with severe RI secondary to AKI. The majority of patients have mild to moderate RI and recover renal function. However, patients with more severe RI, in particular those with a requirement for dialysis, are less likely to recover renal function. Rapid diagnosis and prompt institution of anti-myeloma therapy is an important determinant of renal function recovery, through targeting early and sustained reduction of involved monoclonal FLC. Novel agents are associated with excellent disease response, and bortezomib is now widely used as a first-line agent in the management of MM in patients with severe RI. Extended haemodialysis using high cut-off dialysers is more effective for extracorporeal removal of FLC than plasma exchange, and clinical trials are in process. High-dose chemotherapy with autologous stem cell transplantation does have a role in patients with severe RI but requires careful patient selection. Key Messages: RI is very common in patients with MM, and renal function recovery is associated with improved clinical outcomes. We summarise the epidemiology of MM in the UK, present the impact of RI and renal function recovery on patient outcome, and describe the current management of MM in western countries. Facts from East and West: (1) A serum creatinine level >2 mg/dl has been reported in 16, 21, 24, and 33% of patients with MM in cohort studies from Japan, Europe, China, and Korea, respectively. A creatinine clearance rate <30 ml/min was observed in 30 and 15% of patients in Chinese and Western MM cohorts, respectively. The commonest cause of severe RI in patients with MM is myeloma cast nephropathy. (2) The efficacy of novel treatments (bortezomib, carfilzomib, thalidomide, and lenalidomide) has predominantly been assessed in Western patients. Bortezomib and dexamethasone are the current standard of care for MM and severe RI in the West. Severe RI is not a contraindication to autologous stem cell transplantation (ASCT). Most of the data are from the West; there are case reports from China describing good outcomes with ASCT. The removal of FLC by high-cut-off hemodialysis is under evaluation in randomized controlled trials (RCTs) in the West. Studies in this area are not yet conducted in China. In China, new treatments, such as bortezomib, are more w...

show abstract

“…Among them, only 1 study [13] scored 9 stars, and the other 10 studies [14–23] scored 7 to 8 stars of which 7 studies [15,16,18–21,23] did not specify whether there was specific control for a second important factor and 1 study [22] did not group based on the way of treatment, so the comparability of them obtained only 1 star. Meanwhile, 6 studies [14,15,17–19,22] did not follow up long enough so that the outcome of them obtained only 2 stars.…”

Section: Resultsmentioning

confidence: 99%

Bortezomib-based treatment for multiple myeloma patients with renal impairment

Zhu

Chen

2016

Medicine

View full text Add to dashboard Cite

Background:Renal insufficiency is a common and severe complication of patients with multiple myeloma. The aim of this study was to evaluate bortezomib-based treatment for multiple myeloma patients with renal insufficiency.Methods:The Cochrane Library, Embase, PubMed, ISI, China National Knowledge Infrastructure, Chinese Biomedical Literature Service System, Chongqing VIP Database, and Wan Fang Data were systematically searched to identify observational studies from January 1, 2001, to December 31, 2015. Myeloma response rate and renal remission rate were pooled by using risk ratio and 95% confidence interval (CI). The Cochran Q and I statistics were used to assess heterogeneity. Sensitivity analysis was performed to test the feasibility of pooled results. Publication bias was conducted when included studies were ≥9. Furthermore, grades of evidence were performed to evaluate study quality.Results:Eleven retrospective cohort studies were included in the final analysis. The number of available studies and risk ratios (95% CI) were, respectively, 10 and 1.48 (95% CI: 1.28–1.71) for myeloma overall response, 6 and 3.69 (95% CI: 2.22–6.13) for myeloma complete response, 9 and 1.47 (95% CI: 1.28–1.69) for renal overall remission, and 8 and 1.49 (95% CI: 1.26–1.75) for renal complete remission. No significant publication bias was observed and sensitivity analysis confirmed the stability of results. The overall qualities of evidence were high for myeloma complete response and medium for the other 3 outcomes based on the Grading of Recommendations, Assessment, Development and Evaluation system.Conclusion:Current evidence indicated that bortezomib-based treatment could improve myeloma overall response (especially myeloma complete response) and renal overall remission (including renal complete remission).

show abstract

Bortezomib improves outcome after SCT in multiple myeloma patients with end-stage renal failure

Cited by 15 publications

References 21 publications

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

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

Current Trends of Renal Impairment in Multiple Myeloma

Bortezomib-based treatment for multiple myeloma patients with renal impairment

Contact Info

Product

Resources

About