Tuğçe Nur YİĞENOĞLU, Semi̇h BAŞCI, Mehmet BAKIRTAŞ, Bahar ULU, Derya ŞAHİN, Tahir DARÇIN, Jale YILDIZ, Nuran Ahu BAYSAL, Dicle İSKENDER, Merih KIZIL ÇAKAR, Mehmet DAL, Fevzi ALTUNTAŞ

The Value of International Staging System in Predicting Survival of Multiple Myeloma Patients With Renal Failure

Objectives: At the time of diagnosis, 20 to 30% of multiple myeloma (MM) patients have renal failure. InternationalStaging System (ISS) is based on 2 variables: serum levels of albumin and beta 2-microglobulin (B2M). Serum B2M levelincreases in patients with renal failure. This means that the elevated serum level of B2M is not always correlated withtumor burden in MM patients who have renal failure. Therefore, these patients may have further ISS stages than theyreally have. In this study, we aim to evaluate the success of ISS in predicting survival in MM patients with renal failure.Method: The data of 172 MM patients that underwent autologous stem cell transplantation (ASCT) at our center wereretrospectively analyzed. The patients were divided into 5 renal function stages according to the Renal Disease QualityClassification of the National Kidney Foundation.Results: Overall survival (OS) after ASCT was found 21 months in ISS1 patients, 20 months in ISS2 patients, and 18months in ISS3 patients. OS in stage 0-1 patients was 18 months, it was 30 months in stage 2-3-4-5 patients. There wasno statistically significant difference regarding OS between patients with renal failure and normal renal function in all ISSstages.Conclusion: Our data reveals that the significance of ISS to predict overall survival is independent from renal failure

Renal Yetmezliği Olan Multipl Myelom Hastalarında Uluslararası Evreleme Sisteminin Sağkalımı Göstermedeki Değeri

Giriş: Tanı anında Multipl miyelom (MM) hastalarının % 20 ila % 30'u böbrek yetmezliğine sahiptir. Uluslararası Evreleme Sistemi (ISS) 2 değişkene dayanmaktadır: serum albumin ve beta 2-mikroglobulin (B2M). Serum B2M düzeyi böbrek yetmezliği olan hastalarda artmaktadır. Bu, yüksek B2M seviyesinin böbrek yetmezliği olan MM hastalarında her zaman tümör yüküyle ilişkili olmadığı anlamına gelir. Bu nedenle, bu hastalar gerçekte olduğundan daha üst ISS evresine sahip olabilir. Bu çalışmada, böbrek yetmezliği olan MM hastalarında ISS'nin sağkalımı öngörmedeki başarısını değerlendirmeyi amaçladık. Yöntemler: Merkezimizde otolog kök hücre nakli (OKHN) yapılan 172 MM hastanın verileri retrospektif olarak incelendi. Hastalar Ulusal Böbrek Vakfı Renal Hastalık Kalite Sınıflamasına göre 5 böbrek fonksiyon evresine ayrıldı. Bulgular: OKHN sonrası genel sağkalım (OS), ISS1 hastalarında 21 ay, ISS2 hastalarında 20 ay ve ISS3 hastalarında 18 ay olarak bulundu. Böbrek fonksiyonuna göre evre 0-1 olan hastalarda OS 18 aydı, evre 2-3-4-5 hastalarda 30 aydı. Tüm ISS evrelerinde, böbrek yetmezliği olan hastalar ile normal böbrek fonksiyonları olan hastalar arasında OS açısından istatistiksel olarak anlamlı fark bulunmadı. Sonuç: Verilerimiz, ISS'nin genel sağkalımı öngörmedeki öneminin böbrek yetmezliğinden bağımsız olduğunu ortaya koymaktadır.

PDF

___

1. Rajkumar V. Multiple Myeloma. Curr Probl Cancer 2009; 33: 7–64.

2. Kumar SK, Rajkumar SV, Dispenzieri A, et al. Improved survival in multiple myeloma and the impact of novel therapies. Blood 2008; 111: 2516– 20.

3. Kastritis E, Zervas K, Symeonidis A, et al. Improved survival of patients with multiple myeloma after the introduction of novel agents and the applicability of the International Staging System (ISS): an analysis of the Greek Myeloma Study Group (GMSG). Leukemia 2009; 23: 1152–7.

4. Greipp PR, San Miguel J, Durie BG, et al. International staging system for multiple myeloma. J Clin Oncol 2005; 23: 3412–20.

5. Knudsen LM, Hippe E, Hjorth M, Holmberg E, Westin J. Renal function in newly diagnosed multiple myeloma: A demographic study of 1353 patients. The Nordic Myeloma Study Group. Eur J Haematol 1994; 53: 207–12.

6. Knudsen LM, Hjorth M, Hippe E. Renal failure in multiple myeloma: Reversibility and impact on the prognosis. Nordic Myeloma Study Group. Eur J Haematol 2000; 65: 175–81.

7. Kyle RA, Gertz MA, Witzig TE, et al. Review of 1027 patients with newly diagnosed multiple myeloma. Mayo Clin Proc 2003; 78: 21–33.

8. Irish AB, Winearls CG, Littlewood T. Presentation and survival of patients with severe renal failure and myeloma. QJM 1997; 90: 773–80.

9. Blade J, San Miguel JF, Fontanillas M, et al. Increased conventional chemotherapy does not improve survival in multiple myeloma: long-term results of two PETHEMA trials including 914 patients. Hematol J 2001; 2: 272-8.

10. National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002; 39: S1–S266.

11. Durie BG, Harousseau JL, Miguel JS, et al. International uniform response criteria for multiple myeloma. Leukemia 2006; 20: 1467–73.

12. Dimopoulos M, Kastritis E, Michalis E, et al. The International Scoring System (ISS) for multiple myeloma remains a robust prognostic tool independently of patients’ renal function. Annals of Oncology 2012; 23: 722–9.

13. Pawlyn C, Cairns D, Kaiser M, et al. The relative importance of factors predicting outcome for myeloma patients at different ages: results from 3894 patients in the Myeloma XI trial. Leukemia 2020; 34: 604–12.

14. Alexanian R, Barlogie B, Dixon D. Renal failure in multiple myeloma. Pathogenesis and prognostic implications. Arch Intern Med 1990; 150: 1693–5.

15. Bethea M, Forman DT. Beta 2-microglobulin: its significance and clinical usefulness. Ann Clin Lab Sci 1990; 20: 163–8.

16. Child JA, Kushwaha MR. Serum beta 2- microglobulin in lymphoproliferative and myeloproliferative diseases. Hematol Oncol 1984; 2: 391–401.