TY - JOUR
T1 - Autologous hematopoietic cell transplantation for multiple myeloma patients with renal insufficiency
T2 - A center for international blood and marrow transplant research analysis
AU - Mahindra, A.
AU - Hari, P.
AU - Fraser, R.
AU - Fei, M.
AU - Huang, J.
AU - Berdeja, J.
AU - Callander, N.
AU - Costa, L.
AU - Diaz, M. A.
AU - Freytes, C.
AU - Gale, R. P.
AU - Girnius, S.
AU - Holmberg, L.
AU - Kharfan-Dabaja, M.
AU - Kumar, S.
AU - Kyle, R.
AU - Lazarus, H.
AU - Lee, C.
AU - Maiolino, A.
AU - Moreb, J.
AU - Nishihori, T.
AU - Pawarode, A.
AU - Saad, A.
AU - Savani, B. N.
AU - Schriber, J.
AU - William, B.
AU - Wirk, B. M.
AU - Krishnan, A.
AU - Nieto, Y.
AU - D'Souza, A.
N1 - Publisher Copyright:
© 2017 Macmillan Publishers Limited, part of Springer Nature. All rights reserved.
PY - 2017/12/1
Y1 - 2017/12/1
N2 - 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 (≤3/460 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/m 2 (Mel 200) in 92% (normal/mild), 75% (moderate) and 33% (severe) RI; remainder received 140 mg/m 2 (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/m 2 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.
AB - 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 (≤3/460 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/m 2 (Mel 200) in 92% (normal/mild), 75% (moderate) and 33% (severe) RI; remainder received 140 mg/m 2 (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/m 2 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.
UR - https://www.scopus.com/pages/publications/85041543565
U2 - 10.1038/bmt.2017.198
DO - 10.1038/bmt.2017.198
M3 - Article
C2 - 28920949
AN - SCOPUS:85041543565
SN - 0268-3369
VL - 52
SP - 1616
EP - 1622
JO - Bone Marrow Transplantation
JF - Bone Marrow Transplantation
IS - 12
ER -