Lokman Hekim Tanriverdi, Emin Kaya, Mehmet Ali Erkurt, Ahmet Sarici, Ilhami Berber, Omer Faruk Bahcecioglu, Selim Gok, Irfan Kuku

Comparison of the renal response of bortezomib-based induction and conventional regimen in multiple myeloma patients with renal failure

Aim: Vincristine-doxorubicin-dexamethasone (VAD) was the commonly used first-line treatment for multiple myeloma (MM) patients with renal failure before bortezomib entered clinical practice. In this trial, we aimed to compare the effect of VAD and bortezomibcyclophosphamide-dexamethasone (VCD) chemotherapy regimens on improving kidney function in MM patients with renal failure. Materials and Methods: The records of MM patients in our center between January 2010 and February 2020 were retrospectively analyzed. Patients who received VAD or VCD as a first treatment chemotherapy protocol and whose initially estimated glomerular filtration rate (eGFR) was 50 mL/min/1.73 m2and below were included in the study. Patients were divided into two groups according to the chemotherapy regimens they received. Results: Sixty one MM patients (VAD: 26, VCD: 35) were included in the study. No significant difference was found between the VAD and VCD groups when the baseline, 1st and 2nd month eGFRs were compared (p>0.05). Overall renal response rate (at least minor response) in the VCD group at the end of the 1st month were higher than in the VAD group (p=0.002). Also, renal response rate in the VCD group at the end of the 2nd month were higher than in the VAD group (p=0.033). Conclusion: In MM patients with renal insufficiency, overall renal response rates have increased with the use of VCD instead of VAD as a standard induction regimen.

PDF

___

1. Blade J. Multiple Myeloma. In: Carreras E, Dufour C, Mohty M (eds) The EBMT Handbook. Hematopoietic Stem Cell Transplantation and Cellular Therapies. Cham: Springer, 2019.p.603-7
2. Eleutherakis-Papaiakovou V, Bamias A, Gika D, et al. Renal failure in multiple myeloma: incidence, correlations, and prognostic significance. Leukemıa Lymphoma 2007;48:337-41.
3. Bladé J, Fernández-Llama P, Bosch F, et al. Renal failure in multiple myeloma: presenting features and predictors of outcome in 94 patients from a single institution. Arch Intern Med 1998;158:1889-93.
4. Yadav P, Cook M, Cockwell P. Current trends of renal impairment in multiple myeloma. Kidney Dis (Basel) 2015;1:241-57.
5. Batuman V. The pathogenesis of acute kidney impairment in patients with multiple myeloma. Adv Chronic Kidney Dis 2012;19:282-6.
6. Gonsalves WI, Leung N, Rajkumar SV, et al. Improvement in renal function and its impact on survival in patients with newly diagnosed multiple myeloma. Blood Cancer J 2015; 5:e296.
7. Dimopoulos MA, Delimpasi S, Katodritou E, et al. Significant improvement in the survival of patients with multiple myeloma presenting with severe renal impairment after the introduction of novel agents. Ann Oncol 2014;25:195-200.
8. Uttervall K, Duru AD, Lund J, et al. The use of novel drugs can effectively improve response, delay relapse and enhance overall survival in multiple myeloma patients with renal impairment. PLoS One 2014;9:e101819.
9. Ludwig H, Miguel JS, Dimopoulos MA, et al. International Myeloma Working Group recommendations for global myeloma care. Leukemia 2014;28:981-92.
10. Dimopoulos MA, Kastritis E, Rosinol L, et al. Pathogenesis and treatment of renal failure in multiple myeloma. Leukemia 2008;22:1485-93.
11. Dimopoulos MA, Sonneveld P, Leung N, et al. International Myeloma Working Group Recommendations for the Diagnosis and Management of Myeloma-Related Renal Impairment. J Clin Oncol 2016;34:1544-57.
12. MacLennan ICM, Coope EH, Chapman CE, et al. Renal failure in myelomatosis. Eur J Haematol 1989;43:60-5
13. Augustson BM, Begum G, Dunn JA, et al. Early mortality after diagnosis of multiple myeloma: analysis of patients entered onto the United Kingdom Medical Research Council trials between 1980 and 2002-Medical Research Council Adult Leukaemia Working Party. J Clin Oncol 2005;23:9219-26.
14. Knudsen LM, Hjorth M and Hippe E. Renal failure in multiple myeloma: reversibility and impact on the prognosis Nordic Myeloma Study Group. Eur J Haematol 2000;65:175-81.
15. Dimopoulos MA, Roussou M, Gkotzamanidou M, et al. The role of novel agents on the reversibility of renal impairment in newly diagnosed symptomatic patients with multiple myeloma. Leukemia 2013;27:423-9
16. Kastritis E, Anagnostopoulos A, Roussou M, et al. Reversibility of renal failure in newly diagnosed multiple myeloma patients treated with high dose dexamethasone-containing regimens and the impact of novel agents. Haematologica 2007;92:546-9.
17. Hutchison CA, Cockwell P, Stringer S, et al. Early reduction of serum-free light chains associates with renal recovery in myeloma kidney. J Am Soc Nephrol 2011;22:1129-36.
18. Costa LJ, Abbas J, Ortiz-Cruz KL, et al. Outcomes of patients with multiple myeloma and renal impairment treated with bortezomib, cyclophosphamide, and dexamethasone without plasma exchange. Eur J Haematol 2012;89:432-4.
19. Ludwig H, Drach J, Graf H, et al. Reversal of acute renal failure by bortezomib-based chemotherapy in patients with multiple myeloma. Haematologica 2007;92:1411-4.
20. Sonneveld P, Scheid C, van der Holt B, et al. Bortezomib induction and maintenance treatment improves survival in patients with newly diagnosed multiple myeloma: extended follow-up of the HOVON-65/ GMMG-HD4 Trial. Blood 2013;122:404.
21. Scheid C, Sonneveld P, Schmidt-Wolf IG, et al. Bortezomib before and after autologous stem cell transplantation overcomes the negative prognostic impact of renal impairment in newly diagnosed multiple myeloma: a subgroup analysis from the HOVON-65/ GMMG-HD4 trial. Haematologica 2014;99:148-54.
22. Bao L, Lu J, Huang X. Reversibility of renal insufficiency in patients with newly diagnosed multiple myeloma and the role of different induction regimens. Blood 2014;124:5749.
23. Breitkreutz I, Heiss C, Perne A, et al. Bortezomib improves outcome after SCT in multiple myeloma patients with end-stage renal failure. Bone Marrow Transplant 2014;49:1371-5.