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Kleber M, Ihorst G, Terhorst M, Koch B, Deschler B, Wäsch R, Engelhardt M. Comorbidity as a prognostic variable in multiple myeloma: comparative evaluation of common comorbidity scores and use of a novel MM-comorbidity score. Blood Cancer J 2011; 1:e35. [PMID: 22829196 PMCID: PMC3255252 DOI: 10.1038/bcj.2011.34] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Accepted: 07/07/2011] [Indexed: 12/27/2022] Open
Abstract
Comorbidities have been demonstrated to affect progression-free survival (PFS) and overall survival (OS), although their impact in multiple myeloma (MM) patients is as yet unsettled. We (1) assessed various comorbidities, (2) compared established comorbidity indices (CIs; Charlson comorbidity index (CCI), hematopoietic cell transplantation-specific comorbidity index (HCT-CI)), Kaplan Feinstein (KF) and Satariano index (SI) and (3) developed a MM-CI (Freiburger comorbidity index, FCI) in 127 MM patients. Univariate analysis determined moderate or severe pulmonary disease (hazard ratio (HR): 3.5, P<0.0001), renal impairment (via estimated glomerular filtration rate (eGFR); HR: 3.4, P=0.0018), decreased Karnofsky Performance Status (KPS, HR: 2.7, P=0.0004) and age (HR: 2, P=0.0114) as most important variables for diminished OS. Through multivariate analysis, the eGFR ⩽30 ml/min/1.73m(2), impaired lung function and KPS ⩽70% were significant for decreased OS, with HRs of 2.9, 2.8 and 2.2, respectively. Combination of these risk factors within the FCI identified significantly different median OS rates of 118, 53 and 25 months with 0, 1 and 2 or 3 risk factors, respectively, (P<0.005). In light of our study, comorbidities are critical prognostic determinants for diminished PFS and OS. Moreover, comorbidity scores are important treatment decision tools and will be valuable to implement into future analyses and clinical trials in MM.
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Ludwig H, Adam Z, Hajek R, Greil R, Tóthová E, Keil F, Autzinger EM, Thaler J, Gisslinger H, Lang A, Egyed M, Womastek I, Zojer N. Light Chain–Induced Acute Renal Failure Can Be Reversed by Bortezomib-Doxorubicin-Dexamethasone in Multiple Myeloma: Results of a Phase II Study. J Clin Oncol 2010; 28:4635-41. [DOI: 10.1200/jco.2010.28.1238] [Citation(s) in RCA: 118] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To assess the efficacy of bortezomib-doxorubicin-dexamethasone (BDD) therapy in patients with multiple myeloma with light chain–induced acute renal failure. Patients and Methods Sixty-eight patients with light chain–induced acute renal failure and glomerular filtration rate (GFR) less than 50 mL/min received bortezomib (1.0 mg/m2 on days 1, 4, 8, and 11), doxorubicin (9 mg/m2 on days 1 and 4), and dexamethasone (40 mg on days 1, 4, 8, and 11); if well tolerated after two cycles, bortezomib could be increased to 1.3 mg/m2 and doxorubicin administered on days 1, 4, 8, and 11. Results By intent-to-treat analysis a myeloma response was obtained in 72% of 18 previously and 50 not previously treated patients (complete response [CR]/near CR [nCR], 38%; very good partial response [VGPR], 15%; partial response [PR], 13%; minor response [MR], 6%). Renal response was achieved in 62% of patients (renal CR, 31%; renal PR, 7%; renal MR, 24%). Median GFR increased from 20.5 to 48.4 mL/min. GFR improvement correlated with tumor response; the greatest increase to 59.6 mL/min was seen in the group of patients with CR/nCR/VGPR. Median progression-free survival was 12.1 months. One- and 2-year survival rates were 72% and 58%, respectively. Survival did not differ between patients with and without renal response but was inferior in previously treated patients (P < .001). In multivariate analysis, baseline GFR and tumor response correlated with renal response, and pretreatment status, lactate dehydrogenase, and myeloma response correlated with survival. The most common grade 3 or 4 toxicities were infection (19.1%), thrombocytopenia (14.7%), neutropenia (14.7%), fatigue/weakness (10.3%), and polyneuropathy (8.8%). Conclusion BDD induced a high rate of myeloma and renal responses, and treatment was well tolerated.
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Affiliation(s)
- Heinz Ludwig
- From the Wilhelminenspital; University Hospital Vienna, Vienna; Private Medical University Hospital Salzburg, Salzburg; Hospital Leoben, Leoben; Hospital Wels-Grieskirchen, Grieskirchen; Hospital Feldkirch, Feldkirch, Austria; Masaryk University; Faculty Hospital Brno, Brno, Czech Republic; University Hospital L. Pasteur, Kosice, Slovakia; and Kaposi Mór Teaching Hospital, Kaposvar, Hungary
| | - Zdenek Adam
- From the Wilhelminenspital; University Hospital Vienna, Vienna; Private Medical University Hospital Salzburg, Salzburg; Hospital Leoben, Leoben; Hospital Wels-Grieskirchen, Grieskirchen; Hospital Feldkirch, Feldkirch, Austria; Masaryk University; Faculty Hospital Brno, Brno, Czech Republic; University Hospital L. Pasteur, Kosice, Slovakia; and Kaposi Mór Teaching Hospital, Kaposvar, Hungary
| | - Roman Hajek
- From the Wilhelminenspital; University Hospital Vienna, Vienna; Private Medical University Hospital Salzburg, Salzburg; Hospital Leoben, Leoben; Hospital Wels-Grieskirchen, Grieskirchen; Hospital Feldkirch, Feldkirch, Austria; Masaryk University; Faculty Hospital Brno, Brno, Czech Republic; University Hospital L. Pasteur, Kosice, Slovakia; and Kaposi Mór Teaching Hospital, Kaposvar, Hungary
| | - Richard Greil
- From the Wilhelminenspital; University Hospital Vienna, Vienna; Private Medical University Hospital Salzburg, Salzburg; Hospital Leoben, Leoben; Hospital Wels-Grieskirchen, Grieskirchen; Hospital Feldkirch, Feldkirch, Austria; Masaryk University; Faculty Hospital Brno, Brno, Czech Republic; University Hospital L. Pasteur, Kosice, Slovakia; and Kaposi Mór Teaching Hospital, Kaposvar, Hungary
| | - Elena Tóthová
- From the Wilhelminenspital; University Hospital Vienna, Vienna; Private Medical University Hospital Salzburg, Salzburg; Hospital Leoben, Leoben; Hospital Wels-Grieskirchen, Grieskirchen; Hospital Feldkirch, Feldkirch, Austria; Masaryk University; Faculty Hospital Brno, Brno, Czech Republic; University Hospital L. Pasteur, Kosice, Slovakia; and Kaposi Mór Teaching Hospital, Kaposvar, Hungary
| | - Felix Keil
- From the Wilhelminenspital; University Hospital Vienna, Vienna; Private Medical University Hospital Salzburg, Salzburg; Hospital Leoben, Leoben; Hospital Wels-Grieskirchen, Grieskirchen; Hospital Feldkirch, Feldkirch, Austria; Masaryk University; Faculty Hospital Brno, Brno, Czech Republic; University Hospital L. Pasteur, Kosice, Slovakia; and Kaposi Mór Teaching Hospital, Kaposvar, Hungary
| | - Eva Maria Autzinger
- From the Wilhelminenspital; University Hospital Vienna, Vienna; Private Medical University Hospital Salzburg, Salzburg; Hospital Leoben, Leoben; Hospital Wels-Grieskirchen, Grieskirchen; Hospital Feldkirch, Feldkirch, Austria; Masaryk University; Faculty Hospital Brno, Brno, Czech Republic; University Hospital L. Pasteur, Kosice, Slovakia; and Kaposi Mór Teaching Hospital, Kaposvar, Hungary
| | - Josef Thaler
- From the Wilhelminenspital; University Hospital Vienna, Vienna; Private Medical University Hospital Salzburg, Salzburg; Hospital Leoben, Leoben; Hospital Wels-Grieskirchen, Grieskirchen; Hospital Feldkirch, Feldkirch, Austria; Masaryk University; Faculty Hospital Brno, Brno, Czech Republic; University Hospital L. Pasteur, Kosice, Slovakia; and Kaposi Mór Teaching Hospital, Kaposvar, Hungary
| | - Heinz Gisslinger
- From the Wilhelminenspital; University Hospital Vienna, Vienna; Private Medical University Hospital Salzburg, Salzburg; Hospital Leoben, Leoben; Hospital Wels-Grieskirchen, Grieskirchen; Hospital Feldkirch, Feldkirch, Austria; Masaryk University; Faculty Hospital Brno, Brno, Czech Republic; University Hospital L. Pasteur, Kosice, Slovakia; and Kaposi Mór Teaching Hospital, Kaposvar, Hungary
| | - Alois Lang
- From the Wilhelminenspital; University Hospital Vienna, Vienna; Private Medical University Hospital Salzburg, Salzburg; Hospital Leoben, Leoben; Hospital Wels-Grieskirchen, Grieskirchen; Hospital Feldkirch, Feldkirch, Austria; Masaryk University; Faculty Hospital Brno, Brno, Czech Republic; University Hospital L. Pasteur, Kosice, Slovakia; and Kaposi Mór Teaching Hospital, Kaposvar, Hungary
| | - Miklós Egyed
- From the Wilhelminenspital; University Hospital Vienna, Vienna; Private Medical University Hospital Salzburg, Salzburg; Hospital Leoben, Leoben; Hospital Wels-Grieskirchen, Grieskirchen; Hospital Feldkirch, Feldkirch, Austria; Masaryk University; Faculty Hospital Brno, Brno, Czech Republic; University Hospital L. Pasteur, Kosice, Slovakia; and Kaposi Mór Teaching Hospital, Kaposvar, Hungary
| | - Irene Womastek
- From the Wilhelminenspital; University Hospital Vienna, Vienna; Private Medical University Hospital Salzburg, Salzburg; Hospital Leoben, Leoben; Hospital Wels-Grieskirchen, Grieskirchen; Hospital Feldkirch, Feldkirch, Austria; Masaryk University; Faculty Hospital Brno, Brno, Czech Republic; University Hospital L. Pasteur, Kosice, Slovakia; and Kaposi Mór Teaching Hospital, Kaposvar, Hungary
| | - Niklas Zojer
- From the Wilhelminenspital; University Hospital Vienna, Vienna; Private Medical University Hospital Salzburg, Salzburg; Hospital Leoben, Leoben; Hospital Wels-Grieskirchen, Grieskirchen; Hospital Feldkirch, Feldkirch, Austria; Masaryk University; Faculty Hospital Brno, Brno, Czech Republic; University Hospital L. Pasteur, Kosice, Slovakia; and Kaposi Mór Teaching Hospital, Kaposvar, Hungary
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