Autologous stem cell transplantation for multiple myeloma in patients with reduced renal function: A matched pair comparison.
Shaji Kumar, M.D., Martha Q. Lacy, M.D., Angela Dispenzieri, M.D., Suzanne R. Hayman, M.D., Nelson Leung, M.D., S. Vincent Rajkumar, M.D., Steve Zeldenrust, M.D., John A Lust, M.D., Philip R. Greipp, M.D.,
Robert A. Kyle, M.D., Dennis Gastineau, M.D., Morie A. Gertz, M.D. Division of Hematology, Mayo Clinic, Rochester, MN, United States, 55905.
Background
Results
· Renal insufficiency of varying severity including end stage renal disease requiring dialysis is often a presenting manifestation of
P r o g r e ssi o n F r ee S u r v i v al f r o m
T r a n s p l a n t
multiple myeloma (MM).
1. 0
Cr Cl > = 5 0
·While many improve following initiation of therapy for MM, a considerable number proceed to stem cell transplant with less than
Cr Cl < 5 0
optimal renal function and many receive reduced dose Melphalan for their stem cell transplant.
0. 8
The median post transplant PFS was
·It is not clear whether the long term outcome of their transplants differs from pts with normal renal function or if the toxicity of the
18.2
months
and
18.4
mos
0. 6
transplant is significantly different.
aliv
respectively for the study cohort and
rv
Su
the control group (P=0.4).
0. 4
Patients and Methods
0. 2
· The MM transplant database was searched to identify pts with a Creatinine clearance (Crcl) of less than 50 ml/min/m2 (study cohort).
0. 0
0
2 04 06 0
8 0
1 0 0
1 2 0
1 4 0
·Each of these pts were then matched to two pts with a clearance of > 50 ml/min/m2 (control cohort), based on cytogenetic
T i m e ( m ont h s )
abnormalities (normal vs. abnormal), circulating plasma cells at harvest (yes vs. no), age at transplant, % of plasma cells at transplant,
O v e r al l S u r v i v a l f r o m
T r an sp l a n t
plasma cell labeling index, time to transplant from diagnosis and the disease status at transplant, the factors used in that order of
1. 0
importance.
Cr Cl > =
5 0
Cr Cl <
5 0
· Continuous variables were compared between the two groups using t-test and survival compared by Kaplan Meier analysis.
0. 8
The median overall survival from
0. 6
alivrv
transplant was shorter for the study
Results and Conclusion
Su
cohort (30.7 mos vs. 60 mos for the
0. 4
controls; P = 0.007).
· Eighty pts with a Crcl < 50 ml/min/1.73 m2 were identified and matched to 160 pts with Crcl > 50 ml/min/1.73 m2 (median
0. 2
creatinine 1.7 mg/dL vs 1.0 mg/dL, P <0.0001).
0. 0
·The pts were matched for the above factors and the two groups were similar in terms of their other baseline features except CRP and
0
2 0
4 06 08 0
1 0 0
1 2 0
1 4 0
1 6 0
T i m e
( m ont h s )
B2M, both of which were lower in the control group.
·Pts with reduced renal function were more likely to receive dose reduced Melphalan for conditioning (32.5%) compared to the
Conclusions
control group (2%; P < 0.0001).
·Here we demonstrate that pts with MM and reduced renal function derive disease free survival
·The outcomes from the stem cell transplant were similar in both the groups. 96% of pts obtained an objective response to stem cell
comparable to those with normal function, despite the reduced Melphalan doses.
transplant in each of the groups with no difference in the time to response; and a complete response was seen in 38.5% and 36.6%of
the study and control cohorts respectively (P=NS).
·The toxicity associated with transplant is clearly increased in the presence of abnormal renal
function.
·The time to platelet and neutrophil engraftment was not different between the groups.
·Interestingly, the overall survival was inferior among the pts with reduced renal function. One
·In terms of transplant related toxicity, the median days hospitalized was higher in the study group (5 days vs. 9.5 days; P=0.003) as
possible explanation for this observation is the decreased availability of novel therapies for
was the incidence of grade 3 and 4 mucositis (8% vs. 23%; P= 0.0008). The incidence of bacteremia was similar in the two groups.
salvage among pts with reduced renal function as many of them would not be eligible for
·Six pts (7.5%) had treatment related deaths in the study group compared to 3 pts (2%) among the controls (P=0.03), the majority of
clinical trials due to reduced renal function.
the deaths being infection related.
Disclosures: No relevant conflicts of interest to disclose

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