Faculty Collaboration Database

Autologous hematopoietic cell transplantation for multiple myeloma patients with renal insufficiency: a center for international blood and marrow transplant research analysis. Bone Marrow Transplant 2017 Dec;52(12):1616-1622

Date

09/19/2017

Pubmed ID

28920949

Pubmed Central ID

PMC5859934

DOI

10.1038/bmt.2017.198

Scopus ID

2-s2.0-85041543565 (requires institutional sign-in at Scopus site)   37 Citations

Abstract

Autologous hematopoietic cell transplantation (AHCT) in multiple myeloma (MM) patients with renal insufficiency (RI) is controversial. Patients who underwent AHCT for MM between 2008 and 2013 were identified (N=1492) and grouped as normal/mild (⩾60 mL/min), N=1240, moderate (30-59), N=185 and severe RI (<30), N=67 based on Modification of Diet in Renal Disease. Multivariate analyses of non-relapse mortality (NRM), relapse, PFS and overall survival (OS) were performed. Of the 67 patients with severe RI, 35 were on dialysis prior to AHCT. Patients received melphalan 200 mg/m² (Mel 200) in 92% (normal/mild), 75% (moderate) and 33% (severe) RI; remainder received 140 mg/m² (Mel 140). Thirty four of 35 patients with severe RI achieved post-AHCT dialysis independence. The 5-year PFS for normal, moderate and severe RI was 35 (95% CI, 31-38)%, 40 (31-49)% and 27 (15-40)%, respectively, (P=0.42); 5-year OS for normal, moderate and severe RI was 68 (65-71)%, 68 (60-76)% and 60 (46-74)%, respectively, (P=0.69). With moderate RI, 5-year PFS for high-dose melphalan 140 mg/m² was 18 (6-35)% and for Mel 200 was 46 (36-57)% (P=0.009). With severe RI, 5-year PFS Mel 140 was 25 (11-41) % and for Mel 200 was 32 (11-58)% (P=0.37). We conclude that AHCT is safe and effective in patients with MM with RI.

Author List

Mahindra A, Hari P, Fraser R, Fei M, Huang J, Berdeja J, Callander N, Costa L, Diaz MA, Freytes C, Gale RP, Girnius S, Holmberg L, Kharfan-Dabaja M, Kumar S, Kyle R, Lazarus H, Lee C, Maiolino A, Moreb J, Nishihori T, Pawarode A, Saad A, Savani BN, Schriber J, William B, Wirk BM, Krishnan A, Nieto Y, D'Souza A

Authors

Anita D'Souza MD Associate Professor in the Medicine department at Medical College of Wisconsin
Raphael Fraser PhD Assistant Professor in the Medicine department at Medical College of Wisconsin
Parameswaran Hari MD Adjunct Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Female
Hematopoietic Stem Cell Transplantation
Humans
Male
Melphalan
Middle Aged
Multiple Myeloma
Myeloablative Agonists
Renal Insufficiency
Survival Analysis
Transplantation, Autologous
Young Adult