Effect factors related to a high probability of hemodialysis independence in newly diagnosed multiple myeloma patients requiring hemodialysis

Abstract

Background: Renal failure is a severe complication of symptomatic myeloma, related to higher mortality. Recovery from dialysis dependence can lead to enormous survival benefits. We investigated the effect factors for probability of dialysis independence.

Methods: Retrospective data on 45 newly diagnosed MM (NDMM) patients with serious renal impairment and requiring hemodialysis were analyzed. The statistical methods including logistic regression analysis, Kaplan-Meier survival curves, the log-rank test and the Cox proportional hazards model for survival analysis were used in our study.

Results: Twenty-two of the 45 patients, who were on hemodialysis at diagnosis, became dialysis independence. In the logistic regression analysis, serum level of β2-microglobulin, kidney disease history, involved free light chain, and achieving at least VGPR were significantly associated with reversibility from dialysis dependence. In addition, achieving hemodialysis discontinuation was related to better survival. The multivariate analyses demonstrated that reversibility from dialysis dependence, proteinuria < 3.5 g/24 h, and achieving at least VGPR were significantly associated with OS among NDMM patients requiring hemodialysis.

Conclusion: Lower serum level of β2-microglobulin and lower level of free light chain at diagnosis, achieving at least VGPR, and shorter kidney disease history are related to a high probability of dialysis independence in NDMM patients with serious renal failure requiring dialysis.

Keywords: dialysis independence; effect factors; hemodialysis; multiple myeloma; renal failure.

Figure 1

A, Time to renal response for 45 NDMM patients with severe renal failure requiring hemodialysis. B, Time to major renal response among 45 NDMM patients with severe renal failure requiring hemodialysis. C, Time to dialysis discontinuation for 45 NDMM patients with severe renal failure requiring hemodialysis

Figure 2

Kaplan‐Meier plot comparing (A) overall survival and (B) progression‐free survival between groups 1 and 2 based on their renal function at diagnosis and response to therapy: group 1, on dialysis at diagnosis improved to dialysis discontinuation after therapy; group 2, on dialysis at diagnosis and remained dialysis dependence after therapy