Patients with multiple myeloma requiring long‐term dialysis: presenting features, response to therapy, and outcome in a series of 20 cases

Abstract

From January 1982 to December 1993, 30 patients with multiple myeloma (MM) required haemodialysis (HD) at our institution. The subgroup of 20 patients who survived more than 2 months on HD is the subject of this study. Four patients were already on HD, due to previous nephropathy, when MM was diagnosed. 13 patients presented with acute renal failure and were on dialysis from the time of diagnosis. The remaining three cases developed renal failure later in the course of the disease. The objective response rate was 40% (8/20). Only two patients could discontinue HD (one had a late partial recovery and one received a kidney graft). Mean hospitalization per year was 19.3 d. The subgroup of patients who survived < 1 year spent a mean of 38.3 d in hospital. Whereas in the subgroup with a survival > 1 year mean hospitalization days was 9.6 (P < 0.001). The median survival was 20 months and six patients survived for > 3 years. In summary, patients with MM and severe renal failure who survive the first 2 months on dialysis have an objective response rate to chemotherapy of 40% and a median survival of almost 2 years, with 30% long-term survivors.

Pathogenesis and treatment of renal failure in multiple myeloma

“…5 Although the degree of renal failure is usually moderate and serum creatinine levels are lower than 4 mg per 100 ml, in series from tertiary hospitals up to 10% of patients with newly diagnosed MM have renal failure severe enough to require renal replacement with dialysis at the time of diagnosis. 6 Although it has been generally considered that an additional 25% of patients develop renal failure later in the course of the disease, this is not the experience of the authors of this review. Patients with no nephrotoxic light chains, who do not present with renal failure, are less likely to develop renal insufficiency later during the course of their disease.…”

“…6,52 In one of these studies, patients who survived for more than 1 year spent less than 10 days per year in hospital, a figure similar to that observed in patients on chronic hemodialysis, because of diabetic nephropathy. 6 Apparently, there are no long-term differences between chronic peritoneal dialysis and hemodialysis, although patients on chronic peritoneal dialysis are at a higher risk of developing bacterial peritonitis. 53 In summary, long-term dialysis is a worthwhile treatment for patients with MM and end-stage renal failure.…”

“…On the other hand, if patients who die within the first two months from diagnosis are excluded, the median survival of patients with MM and nonreversible end-stage renal failure is almost 2 years and 30% of them survive for more than 3 years. 6,52 This suggests that the need for long-term dialysis does not adversely affect survival. Another important aspect is the quality of life of this population of patients.…”

“…Despite the improvements in recent years, the mortality rate among patients with MM and dialysis-dependent renal failure during the first two months from diagnosis is about 30%. 6 The response rate to chemotherapy in patients with MM on the long-term dialysis program ranges from 40 to 60%. 6,49-51 Thus, it seems that the presence of renal failure does not have per se a negative impact on the response to chemotherapy.…”

Renal allografts in plasma cell myeloma hematopoietic cell graft recipients: on the verge of an explosion?

“…[4][5][6][7] In early conventional chemotherapy trials, renal failure was found to be a predictor of poor prognosis. Presently, renal failure is considered to reflect a higher tumor burden with a lower median OS, in part reflecting that such patients may receive reduced doses of chemotherapy, have a higher treatment-related mortality or the combination.…”