Restoration of renal function in patients with newly diagnosed multiple myeloma is not associated with improved survival: a population-based study

Abstract

Renal impairment (RI) in patients with multiple myeloma (MM) is associated with poor prognosis. In this population-based cohort study, we assessed the effects of renal response, evaluated according to the IMWG-criteria, on overall survival (OS) in patients with newly diagnosed MM with RI at presentation. All included patients were diagnosed between January 2005 and January 2014 with MM and RI in Friesland, a province of the Netherlands. Of the 131 included patients, 61% achieved renal response. Using a time-varying exposure Cox model, no difference in OS between renal response and non-response was observed (HR = 1.08, 95% CI = 0.67-1.74, p = .76). In multivariable analysis, baseline eGFR <30 ml/min (HR = 1.71), age >70 yrs (HR = 1.77), hypercalcemia (HR = 2.73), lambda Bence-Jones (HR= 1.76), and initial treatment regimen (HR = 0.89 for thalidomide, HR = 1.95 in treatment regimens without novel agents and HR = 3.60 for no chemotherapy, all vs. bortezomib) were associated with decreased OS. In conclusion, achieving renal response was not associated with improved OS.

Survival of patients with cancer starting chronic dialysis: Data from kidney and cancer registries in lower Normandy

“…Patients treated for haematological malignancy had a poorer outcome in our study. This is not surprising, as our subgroup of patients treated for haematological malignancy was mainly constituted by patients with myeloma (14 of 19 patients in that subgroup) requiring dialysis, and as different studies have shown that kidney injury requiring dialysis is an important risk factor for death in patients with myeloma . Therefore, we can say that our result in this subgroup is consistent with previous studies conducted in patients treated for myeloma.…”

Severe renal impairment as an adverse prognostic factor for survival in newly diagnosed multiple myeloma patients

“…Moreover, a multicenter study with 198 consecutive patients has shown increased HRs for impaired OS with deteriorating eGFR by univariable analysis and severe RI as the most relevant prognostic factor for OS via multivariable analysis 8 . Collectively, and similar to our study, these studies reported that severe RI was an independent prognostic factor for decreased OS 8,17,18 …”

“…8 Collectively, and similar to our study, these studies reported that severe RI was an independent prognostic factor for decreased OS. 8,17,18 A review by Yadav et al 9 reported that restoration of renal function in MM was correlated with improved clinical outcomes. More recently, the renal response analysis results from ENDEAVOR trial also showed that achievement of renal responses was associated with greater clinical efficacy in MM patients with RI.…”

Clinicopathologic predictors of renal outcomes in light chain cast nephropathy: a multicenter retrospective study

“…In the previous series that focused on determinants of renal recovery in LCCN, 2 main factors were identified: the severity of renal impairment and the rapid achievement of a deep and sustained hematologic response. 4,6,[29][30][31] Even though deep FLC response is a required condition for renal recovery, it is not sufficient, and identifying reliable predictors of renal prognosis would help in the prognostication and management of LCCN. The present analysis confirms Patients with a minimum 2 months' follow-up and one cycle of treatment were included (n 5 154).…”

“…3,4,18,45,46 However, recent studies have questioned the validity of this relation in the era of novel antimyeloma agents. 31,47,48 These studies were smaller, the definition of renal outcomes varied, initial eGFRs were higher, and the proportion with LCCN was unknown. de Vries et al 31 studied 131 patients newly diagnosed with MM and renal impairment and found that renal recovery was not associated with a better OS, even in patients with severe renal impairment.…”