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Serum Free Light Chain Kinetics Is Predictive of Renal Response in Myeloma Patients With Renal Impairment-An ALLG
P Joy Ho1, Andrew Spencer2, Peter Mollee3
1Institute of Haematology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia; University of Sydney, Sydney, New South Wales, Australia.
Clinical Lymphoma, Myeloma & Leukemia
|May 3, 2024
Summary
Serum free light chain (SFLC) reduction predicts improved kidney function in myeloma patients with renal impairment (RI). A log10 reduction in SFLC by Cycle 2 Day 1 is a target to help avoid dialysis.
Area of Science:
- Nephrology
- Hematology
- Oncology
Background:
- Renal impairment (RI) negatively impacts prognosis in multiple myeloma.
- Reversing RI and preventing dialysis are critical treatment goals.
Purpose of the Study:
- To determine if serum free light chain (SFLC) kinetics can predict renal outcomes in myeloma patients with RI.
- To assess the efficacy and tolerability of carfilzomib-dexamethasone in this cohort.
- To enable therapeutic changes to optimize prognosis and avoid dialysis.
Main Methods:
- 36 myeloma patients with eGFR 15-40 mL/min were treated with carfilzomib-dexamethasone.
- Serum free light chain (SFLC) levels were monitored to assess kinetics.
- Renal function, disease response, survival, and toxicity were evaluated.
Main Results:
- A reduction in SFLC levels correlated with improved eGFR (9.0-15.0 mL/min per log10 reduction).
- Favorable renal outcomes (CRrenal 25%, MRrenal 36%) and disease responses were observed.
- Progression-free and overall survival rates were comparable to patients without RI, despite significant toxicities.
Conclusions:
- A log10 reduction in SFLC by Cycle 2 Day 1 is a potential target for reducing dialysis risk in myeloma patients with RI.
- Patients not reaching this SFLC threshold may benefit from adjusted therapy.
- Carfilzomib-dexamethasone showed efficacy but carried significant toxicity risks in this comorbid population.
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