Publication Only: Myeloma and other monoclonal gammopathies - Clinical
Renal failure (RF) is a common complication of multiple myeloma found in 25% at diagnosis and in 50% during the course of the disease. RF persistence after induction treatment may constitute a factor of ineligibility for autologous stem cell transplantation (ASCT). However, its impact on toxicity and survival post-ASCT is still subject to discussion.
We aimed to compare the toxicity and survival after ASCT in newly diagnosed multiple myeloma (NDMM) patients (pts) with or without RF at diagnosis
Retrospective comparative study of two groups of NDMM pts without RF at diagnosis (Group 1: G1) or with RF at diagnosis (Group 2: G2). These patients were treated according to the Tunisian national referential by dexamethasone, thalidomide +/- bortezomib and transplanted at the hematology department of the national center of bone marrow transplant between January 2011 and December 2016. The IMWG 2014 and IMWG 2016 response criteria were used to assess hematologic and renal response respectively.
Data from 134 patients were analyzed. Median age at ASCT was 54 years (range, 25-65). Sex ratio was 1.2. In all, 114 (85%) and 20 (15%) pts were included in G1 and G2 respectively. In G2, 13 pts (65%) had severe renal impairment at diagnosis; 2 of them required at least one dialysis session. After induction, renal response was complete (70%), partial (15%) or minor (15%). As a pre-transplant conditioning, all pts in G1 received melphalan (MEL) at the dose of 200 mg/m2. In G2, pts received either MEL 200 mg/m2 (85%) or MEL 140 mg/m2 (15%). The two comparative groups were matched with regards to preASCT patient's characteristics and hematological status. In G2 compared to G1, risk of grade ≥3 mucositis (100 vs 51%) was significantly higher, while no significant differences were found in duration of neutropenia (medians 6 vs 6 days), microbiologically documented infection (31 vs 26%), duration of hospitalization (medians: 23 vs 23 days), post-transplant response (ORR; 75 vs 87%), time to progression (median 20 vs 19 months), 5-year PFS (34vs 33%) and OS (61 vs 59%)
Apart from mucositis, ASCT in MM with or without RF was associated with a comparable toxicity and survival rate