Introduction and Aims: Renal impairment (RI) is frequent in patients with Multiple Myeloma (MM) and has been proven to be a prognostic factor regarding overall survival (OS). MM patients with reduced glomerular filtration rate (eGFR) often fail to qualify for high-dose chemotherapy and are excluded from autologous stem cell transplantation (ASCT), since a higher transplant-related mortality has been postulated. However, it remains unclear whether these historical inferior outcome data still hold true in times of modern, immuno-chemotherapeutical therapy regimen.
Methods: 97 MM patients (median age 55 years) who had undergone ASCT between 1997 and 2009 were analyzed. Renal function at the time of transplantation was assessed by eGFR (MDRD). Stratification according to chronic kidney disease (CKD) stages (eGFR cutoff at 90 ml/min, 60 ml/min and 45 ml/min) was carried out and Kaplan-Meier curves and log-rank tests were used for OS and progression-free survival (PFS) calculation.
Results: 62% of all patients had CKD stage II or worse at the time of ASCT. When comparing patients with eGFR ≥ or < 90ml/min, mean OS and PFS did not differ significantly (OS: 133 vs. 95 months, p=0.343; PFS: 86 vs. 69 months, p=0.984, Figure 1 & 2). 20% had CKD stage III or worse, mean OS was 105 vs. 115 months, p=0.321, mean PFS was 79 vs. 88 months, p=0.281. 8% had CKD stage IIIb or worse, mean OS was 109 vs. 119 months, p=0.381, mean PFS was 78 vs. 114 months, p=0.200.
Conclusions: In this retrospective analysis, a relatively large cohort of MM patients who had undergone ASCT was analyzed regarding survival outcome according to renal function at transplantation. Our data show that neither OS nor PFS after ASCT were negatively impacted by mild to moderate RI. Since exclusion from ASCT results in shorter survival per se, it therefore seems to be of pivotal clinical importance that patients with MM and RI should rather be evaluated pro-actively for high-dose immuno-chemotherapy including ASCT than excluded from these therapy regimen.
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