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Parameters Associated With Renal Recovery and Survival in Myeloma Patients With Acute Renal Failure to Cast
Heinz Ludwig1, Meletios Athanasios Dimopoulos2,3, Evangelos Terpos2
1Wilhelminen Cancer Research Institute, c/o Department of Medicine I, Clinic Ottakring, Vienna, Austria.
Abstract:
Acute renal failure due to cast nephropathy (CAN) is a severe complication of multiple myeloma (MM). Here, we aimed to identify parameters associated with renal outcomes and survival in newly diagnosed MM patients with CAN-related acute renal failure and to validate the IMWG criteria for renal response. CAN diagnosis was based on biopsy or clinical assessment. Of 787 registered patients, 354 met the inclusion criteria, requiring at least two therapy cycles with documented chemotherapy response, renal response, and eGFR. Baseline free light chain (FLC) levels (median 6825.65 mg/L) decreased below 500 mg/L in 67.8% of patients. According to IMWG classification, renal complete response, partial response, and minimal response were achieved in 33.9%, 19.5%, and 28.0% of patients, respectively. The best eGFR values > 60 mL/min/1.73 m2 were observed in 33.9% of patients, while 33.3%, 22.3%, and 10.5% had best eGFR values of 30-59, 15-29, and < 15 mL/min/1.73 m2, respectively. Renal response correlated with baseline FLC levels, IgG kappa, eGFR, and ECOG status in multivariate analysis, as well as with myeloma response and FLC reduction in univariate analysis. Median overall survival was 77.6 months. Survival correlated with age, myeloma response, ECOG status, FLC kappa type, baseline eGFR, standard-risk cytogenetics, and calcium levels, among other factors. A comparison of IMWG renal response criteria with classification based solely on best eGFR showed similar utility. Of 136 patients requiring dialysis, 80 (58.8%) were able to discontinue dialysis during therapy. Bortezomib containing myeloma therapy, along with significant FLC reduction, was associated with favorable outcome.
Insights
In multiple myeloma patients with cast nephropathy (CAN)-related acute kidney injury, achieving a significant reduction in free light chain (FLC) levels and responding to bortezomib therapy are key indicators for favorable renal outcomes and survival. These factors, along with baseline FLC levels and eGFR, predict recovery.
Area of Science:
- Nephrology
- Hematology
- Oncology
Background:
- Cast nephropathy (CAN) is a severe complication of multiple myeloma (MM), leading to acute kidney injury.
- Identifying predictors of renal outcomes and survival in MM patients with CAN is crucial for effective treatment strategies.
Purpose of the Study:
- To identify parameters associated with renal outcomes and survival in newly diagnosed MM patients with CAN-related acute renal failure.
- To validate the International Myeloma Working Group (IMWG) criteria for renal response in this patient population.
Main Methods:
- Retrospective analysis of 354 newly diagnosed MM patients with CAN-related acute renal failure who received at least two therapy cycles.
- Evaluation of baseline and on-treatment parameters including free light chain (FLC) levels, estimated glomerular filtration rate (eGFR), myeloma response, and cytogenetics.
- Assessment of renal response using IMWG criteria and classification based on best eGFR values.
Main Results:
- A significant reduction in baseline FLC levels (median 6825.65 mg/L) to below 500 mg/L was achieved in 67.8% of patients.
- Renal response correlated with baseline FLC levels, IgG kappa, eGFR, ECOG status, myeloma response, and FLC reduction.
- Median overall survival was 77.6 months, influenced by age, myeloma response, ECOG status, FLC kappa type, baseline eGFR, cytogenetics, and calcium levels.
- Bortezomib-containing therapy and substantial FLC reduction were associated with favorable outcomes.
- Of 136 patients requiring dialysis, 58.8% were able to discontinue it during therapy.
Conclusions:
- Baseline FLC levels, eGFR, and response to therapy, particularly bortezomib-containing regimens, are critical for predicting renal recovery and survival in MM patients with CAN.
- The IMWG renal response criteria demonstrated utility comparable to classification based solely on best eGFR.
- Significant FLC reduction is a key factor in achieving favorable outcomes and enabling dialysis discontinuation.
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