Autologous stem cell transplantation for multiple myeloma patients with chronic kidney disease: a safe and effective option

Abstract

Chronic Kidney Disease (CKD) is a frequent complication in patients with multiple myeloma (MM) and is associated with adverse outcomes. The use of autologous stem cell transplantation (ASCT) has improved disease outcomes, however, the safety and efficacy of ASCT in patients with CKD has been the subject of debate. To investigate this, we conducted a retrospective analysis of 370 MM patients who underwent their first ASCT, including those with mild, moderate and severe CKD as well as normal renal function at the time of transplant. No significant difference in ASCT-related mortality, Progression-Free or Overall Survival was noted between the different renal function groups. A decline in estimated glomerular filtration rate (eGFR) at 1-year of >8.79% was associated with poorer overall survival (p < 0.001). The results of this study show that ASCT is a safe and effective option for myeloma patients with CKD, including those on dialysis. Patients who demonstrate renal deterioration at 1-year post-transplant should be closely monitored as this is a predictor for poor survival.

Fig. 1. Renal response of patients with multiple myeloma following ASCT.

a Box and Whisker plot illustrating the median eGFR at the time of transplant (Day 0) and at days 30 (D + 30) and 365 (D + 365) post-transplant. b Table displaying change in eGFR categories between D0 and D + 100, and D0 and D + 365 post transplant. A onestep increase in eGFR category is denoted by +1 and a two-step increase by +2; −1 and −2 represent a one and twostep decrease in eGFR category respectively. A total of 45 patients improved their renal function to an eGFR of 60–90 ml/min/1.73 m² category at D + 100 and 52 patients at D + 365 after transplant. Two patients normalised their renal function after transplant. There were only two patients with a drop in eGFR to <30 ml/min/1.73m² at both D + 100 and D + 365 post-transplant, suggesting an at least safe, if not beneficial, impact of autologous transplant on renal function. N number of patients.

Fig. 2. Outcomes of multiple myeloma patients following ASCT.

a Overall survival and b progression free survival. Kaplan–Meier estimates showing no significant difference between the various eGFR groups (p = 0.84 and p = 0.66, respectively).

Fig. 3. Outcomes of patients with multiple myeloma based on individual eGFR change between Day 0 and Day + 365 following ASCT.

a Overall survival, b progression free survival and c progression free survival 2 (PFS2). A significantly worse OS was seen in Q₄ (>8.79% worsening eGFR group) (p < 0.001) but no significant difference was noted in PFS at one year post transplant between the four quartiles (p = 0.75). PFS2 in a subpopulation of patients (n = 108) showed a significant difference between Q₄ and the remaining cohorts (Q_1–3) (p < 0.001).