Renal failure in multiple myeloma: incidence, correlations, and prognostic significance
V Eleutherakis-Papaiakovou1, A Bamias, D Gika
1Department of Clinical Therapeutics, University of Athens, School of Medicine, Greece.
Abstract:
Renal failure (RF) is a common and severe complication of patients with multiple myeloma (MM). The purpose of our study was to assess the incidence of RF in a contemporary series of newly diagnosed patients with MM, its association with specific clinical and laboratory features, and its impact on patients' outcome. Over the last decade, 756 newly diagnosed symptomatic patients with MM were included in our database. Renal failure, defined as a serum creatinine >or= 2 mg/dl at the time of diagnosis, was seen in 21% of patients. Multiple parameters were associated with RF, but logistic regression analysis showed that RF was independently associated only with International Staging System and Bence Jones proteinuria. The presence of RF was associated with a trend for higher early death rate but with a similar response to primary therapy. The median survival of patients with RF was 19.5 months versus 40.4 months for patients without RF (p < 0.001). Several variables were associated with impaired survival by univariate analysis. When multivariate analysis was performed the independent variables were poor performance status, thrombocytopenia, advanced age, high LDH and elevated serum beta2 microglobulin but not high creatinine. When corrected for stage, renal failure had no impact on survival.
Insights
Renal failure (RF) affects 21% of multiple myeloma (MM) patients at diagnosis. While RF impacts survival, it is not an independent predictor when considering disease stage.
Area of Science:
- Hematology
- Nephrology
- Oncology
Background:
- Renal failure (RF) is a frequent and serious complication in multiple myeloma (MM).
- Understanding RF incidence and impact is crucial for MM patient management.
Purpose of the Study:
- To determine the incidence of RF in newly diagnosed MM patients.
- To identify clinical and laboratory factors associated with RF.
- To evaluate the impact of RF on MM patient outcomes.
Main Methods:
- Analysis of a database of 756 newly diagnosed symptomatic MM patients.
- Definition of RF as serum creatinine >or= 2 mg/dl at diagnosis.
- Logistic regression and multivariate analyses to assess associations and independent predictors.
Main Results:
- RF was present in 21% of MM patients.
- RF was independently associated with the International Staging System and Bence Jones proteinuria.
- RF showed a trend toward higher early mortality but similar treatment response.
- Median survival was significantly lower for patients with RF (19.5 months) versus without RF (40.4 months).
- Multivariate analysis identified poor performance status, thrombocytopenia, advanced age, high LDH, and elevated beta2 microglobulin as independent survival predictors, but not high creatinine.
Conclusions:
- RF is a significant comorbidity in MM, associated with poorer survival.
- When adjusted for disease stage, RF itself is not an independent predictor of survival.
- Clinical and laboratory features, alongside staging, are critical for prognostic assessment in MM patients with RF.
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