Improvement in renal function and its impact on survival in patients with newly diagnosed multiple myeloma

Abstract

Renal impairment (RI) is seen in over a quarter of patients with newly diagnosed multiple myeloma (NDMM). It is not clear if reversal of RI improves the outcome to that expected for NDMM patients without RI. We evaluated 1135 consecutive patients with NDMM seen at the Mayo Clinic between January 2003 and December 2012. RI was defined as having a creatinine clearance (CrCl) <40ml/min. The median overall survival (OS) for patients with RI at diagnosis receiving and not receiving novel agent induction therapy was not reached vs 46 months (P<0.001). The median OS for patients with CrCl ⩾40 ml/min at diagnosis, CrCl <40 ml/min at diagnosis but improved to ⩾40 ml/min and CrCl <40 ml/min at diagnosis and remained <40 ml/min, were 112, 56 and 33 months, respectively (P<0.001). The complete renal response rate for patients with RI at diagnosis receiving novel agent induction therapy compared to the rest was 40 vs 16% (P<0.001). In conclusion, patients with reversal of RI have improved outcomes, but it remains inferior to patients with normal renal function at diagnosis. These results have implications for identifying early treatment strategies for patients at risk of developing renal insufficiency.

Figure 1

(a) Kaplan-Meier plot comparing overall survival between patients based on the presence or absence of a creatinine >2 mg/dl at diagnosis. (b) Kaplan-Meier plot comparing overall survival between patients based on the presence of an estimated creatinine clearance ⩾40 ml/min at diagnosis.

Figure 2

Kaplan-Meier plot comparing overall survival between patients with an estimated creatinine clearance of <40 ml/min based on the presence or absence of a novel agent induction regimen.

Figure 3

(a) Kaplan-Meier plot comparing overall survival between groups 1, 2, and 3 based on their renal function at diagnosis and response to therapy: group 1, CrCl⩾40 at diagnosis; group 2, CrCl<40 at diagnosis but improved to ⩾40 after therapy; and group 3, CrCl<40 at diagnosis and remained <40 after therapy. (b) Kaplan-Meier plot comparing overall survival at a 6-month landmark based on their renal function at diagnosis and response to therapy: group 1, CrCl⩾40 at diagnosis; group 2, CrCl<40 at diagnosis but improved to ⩾40 after therapy; and group 3, CrCl<40 at diagnosis and remained <40 after therapy.