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Published on: April 12, 2017
Incidence, Clinical Features, and Prognostic Value of New-Onset Renal Impairment in Multiple Myeloma
Xiang Liu1,2,3, Qian Hu1,2,3, Yuhuan Zheng1,2,3
1Department of Hematology, Institute of Hematology, West China Hospital, Sichuan University, Chengdu, China.
Background:
Previous studies mainly focused on renal impairment (RI) at multiple myeloma (MM) diagnosis, with few investigating new-onset RI post-MM diagnosis. This study aims to indicate the incidence, clinical characteristics and predictive value of new-onset RI in MM patients.
Methods:
We conducted a multicenter, retrospective cohort study including 1953 newly diagnosed MM patients from West China Hospital from July 1, 2008, to February 30, 2024 and the international MMRF-CoMMpass database. Among them, 1770 patients received novel therapeutic agents including immunomodulatory drugs (IMiDs) and proteasome inhibitors (PIs) as first-line therapy. RI was defined as serum creatinine higher than 2 mg/dL or impaired creatinine clearance (< 40 mL/min/1.73m2). The association between new-onset RI and mortality risk was investigated by Kaplan-Meier analysis and Cox proportional hazard models.
Results:
Of the cohort, 16.6% developed new-onset RI, with the majority (67.1%) occurring within 2 years post-MM diagnosis. The median overall survival (OS) was significantly shorter in new-onset RI than in those without RI (68 vs. 122 months, p < 0.001). New-onset RI was an independent risk factor for mortality (HR 1.55, 95% CI 1.28-1.88, p < 0.001), and earlier onset of RI was associated with a higher mortality risk. Moreover, patients with recovery of renal function had prolonged OS compared to those without recovery (95 vs. 64.8 months, p = 0.01). Older age, higher stage of the international stage system (ISS) and RI at diagnosis seemed to be risk factors for new-onset RI, while first-line therapy with PIs and IMiDs combinations was associated with a lower risk of RI development (HR 0.69, 95% CI 0.51-0.94, p = 0.017).
Conclusions:
In conclusion, the incidence of new-onset RI is high in MM, and is a significant risk factor for mortality, posing a substantial threat to MM patients. Early identification of high-risk patients for new-onset RI and prompt preventive strategies is critical for improving MM prognosis.
Trial Registration:
This study was registered by the Chinese Clinical Trial Registry (ChiCTR2400081476, https://www.chictr.org.cn).
Insights
New-onset renal impairment (RI) affects 16.6% of multiple myeloma (MM) patients and is a significant risk factor for mortality. Early identification and prevention strategies are crucial for improving MM patient outcomes.
Area of Science:
- Hematology
- Nephrology
- Oncology
Background:
- Previous research on multiple myeloma (MM) primarily focused on renal impairment (RI) at diagnosis.
- Limited studies have investigated the incidence and impact of new-onset RI after MM diagnosis.
Purpose of the Study:
- To determine the incidence and clinical characteristics of new-onset RI in MM patients.
- To evaluate the predictive value of new-onset RI for mortality risk in MM.
Main Methods:
- A multicenter retrospective cohort study included 1953 newly diagnosed MM patients.
- RI was defined as serum creatinine >2 mg/dL or creatinine clearance <40 mL/min/1.73m².
- Kaplan-Meier analysis and Cox proportional hazard models assessed mortality risk.
Main Results:
- 16.6% of MM patients developed new-onset RI, mostly within 2 years of diagnosis.
- New-onset RI significantly reduced overall survival (OS) and was an independent mortality risk factor (HR 1.55).
- Older age, higher ISS stage, and RI at diagnosis were risk factors for new-onset RI; PI and IMiD combination therapy lowered RI risk.
Conclusions:
- New-onset RI is common in MM patients and significantly increases mortality risk.
- Early detection of high-risk individuals and prompt intervention are vital for improving MM prognosis.
- Recovery of renal function was associated with improved OS.
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