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Submitted: 01 Aug 2022
Accepted: 12 May 2023
ePublished: 04 Apr 2024
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J Renal Inj Prev. 2024;13(2): e32105.
doi: 10.34172/jrip.2024.32105
  Abstract View: 147
  PDF Download: 53

Original

Treatment outcomes of multiple myeloma in patients requiring renal replacement therapy

Aruni Ratnayake 1,2* ORCID logo, Mukunthan Srikantharajah 1 ORCID logo, Simon Stern 3 ORCID logo, David Makanjuola 1 ORCID logo

1 Department of Nephrology, St. Helier Hospital, Wrythe Lane, Sutton, Carshalton, SM5 1AA, United Kingdom
2 Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, Hammersmith Campus, Du Cane Road, London W12 0NN, United Kingdom
3 Department of Haematology, St Helier Hospital, Wrythe Lane, Sutton, Carshalton, SM5 1AA, United Kingdom
*Corresponding Author: Aruni Ratnayake, Email: a.ratnayake20@imperial.ac.uk, Email: aruni.ratnayake@nhs.net

Abstract

Introduction: Renal impairment is a recognised complication of multiple myeloma (MM). Bortezomib and dexamethasone are used as first line therapy but are associated with important side effects.

Objectives: We investigated outcomes of patients with MM requiring renal replacement therapy (RRT), assessed renal and haematological responses, and compared effects of different chemotherapy regimens.

Patients and Methods: Retrospective study of 67 patients with MM with associated renal impairment managed at our centre from 2007–2017. Approximately 29 patients required RRT and were included in the final analysis.

Results: Bortezomib was administered to treat 65.5% patients; overall response rate was 84.2% (complete 21.1%, partial 63.1%). The remaining patients were treated with other agents; of these 50% responded to therapy, all with partial response. Bortezomib was associated with improved survival (P=0.02), however a higher proportion of patients experienced side effects (P=0.02). Of the patients who received bortezomib, 47% came off RRT, compared to 10% of patients who did not (P=0.04). Independence from RRT had the best association with survival (P=0.07). Patients who came off RRT had significant reduction in serum free light chains after two cycles of chemotherapy; those remaining dialysis-dependent showed variable changes in free light chain levels (P=0.02).

Conclusion: Bortezomib treatment resulted in a significant improvement in survival, albeit with more side effects. Gaining independence from RRT was associated with better patient survival. A greater degree of reduction of free light chains corresponded to an increased likelihood of being independent of dialysis; this could be used as a marker for renal recovery and overall prognosis.


Implication for health policy/practice/research/medical education:

Current treatment regimens for multiple myeloma include bortezomib and dexamethasone. These regimens, although effective, are associated with side effects. We reviewed the outcomes of treatment of patients with multiple myeloma requiring renal replacement therapy in our centre. Our study highlights that bortezomib therapy is associated with improved renal and mortality outcomes, with greater chance of gaining dialysis independence compared to regimens including thalidomide or conventional chemotherapy alone. However, it is associated with significant side effects. Better light chain response to chemotherapy is a potential marker for recovery of renal function and overall improved prognosis in patients with multiple myeloma and renal impairment. We found bortezomib is associated with more favourable renal and mortality outcomes in patients with renal failure needing renal replacement therapy. However, the drug’s side effect profile adds to clinical morbidity. A greater degree of reduction of light chains corresponds to an increased likelihood of being independent of dialysis. This reinforces the importance of timely and prompt treatment of multiple myeloma, as renal failure, particularly dialysis dependence, is associated with a higher mortality.

Please cite this paper as: Ratnayake A, Srikantharajah M, Stern S, Makanjuola D. Treatment outcomes of multiple myeloma in patients requiring renal replacement therapy. J Renal Inj Prev. 2024; 13(2): e32105. doi: 10.34172/jrip.2024.32105.

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