1
|
Dimopoulos MA, Merlini G, Bridoux F, Leung N, Mikhael J, Harrison SJ, Kastritis E, Garderet L, Gozzetti A, van de Donk NWCJ, Weisel KC, Badros AZ, Beksac M, Hillengass J, Mohty M, Ho PJ, Ntanasis-Stathopoulos I, Mateos MV, Richardson P, Blade J, Moreau P, San-Miguel J, Munshi N, Rajkumar SV, Durie BGM, Ludwig H, Terpos E. Management of multiple myeloma-related renal impairment: recommendations from the International Myeloma Working Group. Lancet Oncol 2023; 24:e293-e311. [PMID: 37414019 DOI: 10.1016/s1470-2045(23)00223-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/02/2023] [Accepted: 05/05/2023] [Indexed: 07/08/2023]
Abstract
Here, the International Myeloma Working Group (IMWG) updates its clinical practice recommendations for the management of multiple myeloma-related renal impairment on the basis of data published until Dec 31, 2022. All patients with multiple myeloma and renal impairment should have serum creatinine, estimated glomerular filtration rate, and free light chains (FLCs) measurements together with 24-h urine total protein, electrophoresis, and immunofixation. If non-selective proteinuria (mainly albuminuria) or involved serum FLCs value less than 500 mg/L is detected, then a renal biopsy is needed. The IMWG criteria for the definition of renal response should be used. Supportive care and high-dose dexamethasone are required for all patients with myeloma-induced renal impairment. Mechanical approaches do not increase overall survival. Bortezomib-based regimens are the cornerstone of the management of patients with multiple myeloma and renal impairment at diagnosis. New quadruplet and triplet combinations, including proteasome inhibitors, immunomodulatory drugs, and anti-CD38 monoclonal antibodies, improve renal and survival outcomes in both newly diagnosed patients and those with relapsed or refractory disease. Conjugated antibodies, chimeric antigen receptor T-cells, and T-cell engagers are well tolerated and effective in patients with moderate renal impairment.
Collapse
Affiliation(s)
- Meletios A Dimopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | - Giampaolo Merlini
- Amyloidosis Research and Treatment Center, IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Frank Bridoux
- Department of Nephrology, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, France
| | - Nelson Leung
- Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Joseph Mikhael
- Translational Genomics Research Institute, City of Hope Cancer Center, Phoenix, AZ, USA
| | - Simon J Harrison
- Peter MacCallum Cancer Centre, Royal Melbourne Hospital, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Efstathios Kastritis
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | | | - Alessandro Gozzetti
- Department of Hematology, University of Siena, Policlinico S Maria alle Scotte, Siena, Italy
| | - Niels W C J van de Donk
- Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Katja C Weisel
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ashraf Z Badros
- Department of Medicine, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Meral Beksac
- Department of Hematology, Ankara University School of Medicine, Ankara, Turkey
| | | | - Mohamad Mohty
- Department of Hematology, Hôpital Saint-Antoine, Sorbonne University and INSERM UMRs 938, Paris, France
| | - P Joy Ho
- Institute of Haematology, Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia
| | - Ioannis Ntanasis-Stathopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | | | - Paul Richardson
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Joan Blade
- Department of Hematology, Hospital Clinic, IDIBAPS, Barcelona, Spain
| | - Philippe Moreau
- Department of Hematology, University Hospital of Nantes, Nantes, France
| | - Jesus San-Miguel
- Cancer Center Clinica Universidad de Navarra, CCUN, Centro de Investigación Médica Aplicada, Instituto de Investigación Sanitaria de Navarra, Centro de Investigación Biomédica en Red Cáncer, Pamplona, Spain
| | - Nikhil Munshi
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | | | - Brian G M Durie
- Department of Hematology/Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Heinz Ludwig
- Wilhelminen Cancer Research Institute, First Department of Medicine, Clinic Ottakring, Vienna, Austria
| | - Evangelos Terpos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece.
| |
Collapse
|
2
|
Leung N, Rajkumar SV. Multiple myeloma with acute light chain cast nephropathy. Blood Cancer J 2023; 13:46. [PMID: 36990996 PMCID: PMC10060259 DOI: 10.1038/s41408-023-00806-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 03/31/2023] Open
Abstract
Light chain cast nephropathy (LCCN) is a leading cause of acute kidney injury (AKI) in patients with multiple myeloma (MM) and is now defined as a myeloma defining event. While the long-term prognosis has improved with novel agents, short-term mortality remains significantly higher in patients with LCCN especially if the renal failure is not reversed. Recovery of renal function requires a rapid and significant reduction of the involved serum free light chain. Therefore, proper treatment of these patients is of the utmost importance. In this paper, we provide an algorithm for treatment of MM patients who present with biopsy-proven LCCN or in those where other causes of AKI have been ruled out. The algorithm is based on data from randomized trial whenever possible. When trial data is not available, our recommendations is based on non-randomized data and expert opinions on best practices. We recommend that all patients should enroll in a clinical trial if available prior to resorting to the treatment algorithm we outlined.
Collapse
Affiliation(s)
- Nelson Leung
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA.
| | | |
Collapse
|
3
|
Dimopoulos MA, Mikhael J, Terpos E, Leleu X, Moreau P, Bladé J, Kim JS, Stockerl-Goldstein K, Richardson PG. An overview of treatment options for patients with relapsed/refractory multiple myeloma and renal impairment. Ther Adv Hematol 2022; 13:20406207221088458. [PMID: 35392438 PMCID: PMC8980434 DOI: 10.1177/20406207221088458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/02/2022] [Indexed: 11/16/2022] Open
Abstract
Renal impairment (RI) is a relatively common complication of multiple myeloma, which increases in frequency as disease becomes more advanced and recovery of renal function becomes less likely as patients progress through lines of therapy. Clinical trials in the relapsed/refractory multiple myeloma (RRMM) setting have not uniformly included patients with RI or robustly reported their outcomes. Here, we review existing data among patients with RI and RRMM across drug classes (including immunomodulatory agents, proteasome inhibitors, monoclonal antibodies, antibody-drug conjugates, chimeric antigen receptor T-cell therapies, and exportin-1 inhibitor) to provide an improved understanding of available treatment options for this important population. We highlight data from pivotal clinical trials, including data relating to renal response (as defined by the International Myeloma Working Group) and discuss real-world experiences in patients with RI, where applicable. Despite substantial advances in RRMM treatment, the presence of RI remains associated with reduced overall survival. Consistent inclusion of patients with RI, and uniform reporting of their outcomes, should be encouraged in future prospective trials of treatments for RRMM.
Collapse
Affiliation(s)
- Meletios A. Dimopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Joseph Mikhael
- Applied Cancer Research and Drug Discovery Division at the Translational Genomics Research Institute (TGen), City of Hope Cancer Center, Phoenix, AZ, USA
| | - Evangelos Terpos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Xavier Leleu
- Service d’Hématologie et Thérapie Cellulaire, CHU and CIC Inserm 1402, Poitiers Cedex, France
| | | | - Joan Bladé
- Hospital Clínic de Barcelona/IDIBAPS, Barcelona, Spain
| | - Jin Seok Kim
- Division of Hematology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Keith Stockerl-Goldstein
- Division of Oncology, Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Paul G. Richardson
- Dana Farber Cancer Institute, 450 Brookline Avenue, 44 Binney St., Boston, MA 02115, USA
| |
Collapse
|
4
|
Rana R, Cockwell P, Drayson M, Cook M, Pratt G, Cairns DA, Pawlyn C, Jackson G, Davies F, Morgan G, Pinney JH. Renal outcome in patients with newly diagnosed multiple myeloma: results from the UK NCRI Myeloma XI trial. Blood Adv 2020; 4:5836-5845. [PMID: 33232472 PMCID: PMC7686889 DOI: 10.1182/bloodadvances.2020002872] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 10/16/2020] [Indexed: 12/25/2022] Open
Abstract
Renal injury is a common complication of multiple myeloma (MM) and is associated with adverse outcome. Despite this, the natural history of renal injury in patients with MM remains uncertain especially in the context of intensive therapy and novel therapies. To address the lack of data, we evaluated the renal function of 2334 patients from the UK National Cancer Research Institute Myeloma XI trial at baseline and at 12 months to assess renal function over time and the factors associated with change. Patients who had severe acute kidney injury or a requirement for dialysis were excluded. At 12 months of the 1450 evaluable patients planned for autologous transplantation; 204 (14%) patients had a decline in estimated glomerular filtration rate (eGFR) ≥25% from baseline, 341 (23.5%) had an improvement and 905 (62%) had no significant change in eGFR. Renal outcome at 12 months for the 884 evaluable patients who were not planned for transplant was similar. Improved renal function was more likely if patients were <70 years old, male, had an average eGFR <60 mL per minute per 1.73 m2 and a higher baseline free light chain level >1000 mg/L, and/or a free light chain response of >90%. It did not correlate with monoclonal-protein response, transplantation, or use of a bortezomib-based regimen. We show that with current therapies the proportion of patients who have a significant decline in renal function in the first 12 months is small. The greatest relative improvement in eGFR is seen in patients with high free light chain at baseline and a high light chain response. This trial was registered at http://www.isrctn.com as #49407852.
Collapse
Affiliation(s)
- Ritika Rana
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Paul Cockwell
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Mark Drayson
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Mark Cook
- Department of Haematology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Guy Pratt
- Department of Haematology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - David A Cairns
- Clinical Trials Unit, University of Leeds, Leeds, United Kingdom
| | | | - Graham Jackson
- Department of Haematology, University of Newcastle, Newcastle-upon-Tyne, United Kingdom; and
| | - Faith Davies
- Perlmutter Cancer Center, NYU Langone Health, New York, NY
| | - Gareth Morgan
- Perlmutter Cancer Center, NYU Langone Health, New York, NY
| | - Jennifer Helen Pinney
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| |
Collapse
|
5
|
Sun G, Wang J, Wang P, Ren H, Yue Y, Song Z, Fu X. Donepezil protects glycerol-induced acute renal failure through the cholinergic anti-inflammatory and nitric oxide pathway in rats. Immunopharmacol Immunotoxicol 2020; 42:625-631. [PMID: 33183119 DOI: 10.1080/08923973.2020.1835950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVES Inflammation as well as oxygen metabolite play important roles in renal injury during pathogenesis of rhabdomyolysis induced myoglobinuric acute renal failure (ARF). The aim of this study was to investigate the protective effects of donepezil on immune responses in rats with glycerol-induced ARF. METHODS Sixty male rats were randomly divided into six groups, the rats were given normal saline (10 ml/kg, i.m.), glycerol (50%, 10 ml/kg, i.m.), glycerol plus dexamethasone (0.1 mg/kg, i.g.), and glycerol plus donepezil (1, 5 and 10 mg/kg, i.g.) respectively. After two weeks of glycerol injections, the kidney tissues and blood samples were harvested for future biochemical and pathology analysis. The levels of creatinine (Cr) and urea nitrogen (BUN) in plasma, the content of malondialdehyde (MDA), glutathione (GSH), and superoxide dismutase (SOD) activity, total nitric oxide synthase (TNOS), inducible nitric oxide synthase (iNOS), endothelial NO synthase (eNOS) were evaluated in renal tissues. In addition, interleukin-6 (IL-6), tumor necrosis factors-α (TNF-α) in renal tissues were also determined. RESULTS Donepezil treatment protected rats from renal dysfunction in a dose-dependent manner and through the cholinergic anti-inflammatory pathway. Additionally, donepezil significantly reduced tubular damages, prevented neutrophil infiltration and decreased productions of the IL-6, TNF-α, nitric oxide content and oxidative damage. CONCLUSIONS These data indicate that donepezil exerts a protective anti-inflammatory effect during ARF through the cholinergic pathway and Nitric oxide pathway. In addition, this study could provide an opportunity to overcome the effect of surgical cholinergic denervation during kidney transplantation and other injury.
Collapse
Affiliation(s)
- Guodong Sun
- Department of Pharmacy, Liaocheng People's Hospital, Liaocheng, Shandong, P. R. China
| | - Jialei Wang
- Department of Urology, Liaocheng People's Hospital, Liaocheng, Shandong, P. R. China
| | - Pan Wang
- Department of Nephrology, Liaocheng Dongchangfu People's Hospital, Liaocheng, Shandong, P. R. China
| | - Huimin Ren
- Department of Eastern Operating Room, Liao Cheng People's Hospital, Liaocheng, Shandong, P. R. China
| | - Yuedong Yue
- Department of Pharmacy, Liaocheng People's Hospital, Liaocheng, Shandong, P. R. China
| | - Zhengmin Song
- Department of Pharmacy, Liaocheng People's Hospital, Liaocheng, Shandong, P. R. China
| | - Xiaobin Fu
- Department of Pharmacy, Liaocheng People's Hospital, Liaocheng, Shandong, P. R. China
| |
Collapse
|
6
|
Rekhtina IG, Kazarina EV, Stolyarevich ES, Kovrigina AM, Dvirnyk VN, Kulikov SM, Mendeleeva LP. [Morphological and immunohistochemical predictors of renal response to therapy patients with myeloma cast nephropathy and dialysis-dependent acute kidney injury]. TERAPEVT ARKH 2020; 92:63-69. [PMID: 33346446 DOI: 10.26442/00403660.2020.07.000776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Indexed: 11/22/2022]
Abstract
AIM Reveal morphological and immunohistochemical predictors of reversibility of dialysis-dependent acute kidney injury (AKI) in patients with myeloma cast nephropathy (MCN) based on the study of kidney biopsy. MATERIALS AND METHODS Renal pathological findings were studied in 36 patients with MCN and dialysis-dependent stage 3 AKI (AKIN, 2012). The study of biopsy samples was performed by a semi-quantitative and quantitative analysis using computer morphometry. The expression of E-cadherin, vimentin and-smooth muscle actin was determined immunohistochemically in the tubular cells and interstitium. Induction therapy for 26 patients was carried out to bortezomib-based programs; in 10 patients other schemes were used. A comparative analysis of morphological changes in nephrobiopathy depending on the renal response was performed in patients with achieved hematologic remission. RESULTS Improved renal function was observed only in patients with hematologic response to therapy. There were no differences in the number of sclerotic glomeruli, protein casts, the area of inflammatory interstitial infiltration, and the degree of acute tubular damage in patients with and without renal response. In patients with renal response compared with patients without improving renal function, the area of interstitial fibrosis was less (24.9% and 45.9%, respectively;p=0.001), and the area of E-cadherin expression was larger (15.9% and 7.1%, respectively;p=0.006). Interstitial fibrosis of 40% or more and/or the area of expression of E-cadherin less than 10% of the area of tubulo-interstitium have an unfavorable prognostic value in achieving a renal response in MCN. CONCLUSION If the interstitial fibrosis area is 40% or more and the expression area of E-cadherin is less than 10%, the probability of the absence of a renal response is 93.3% (OR=24.5) even when a hematological response to induction therapy is achieved. The number of protein casts, the prevalence of acute tubular damage and inflammatory interstitial infiltration have not prognostic value.
Collapse
Affiliation(s)
| | | | - E S Stolyarevich
- Moscow City Nephrology Center, Moscow City Hospital 52.,Yevdokimov Moscow State University of Medicine and Dentistry
| | - A M Kovrigina
- National Research Center for Hematology.,Federal Research Clinical Center of Specialized Types of Medical Care and Medical Technologies
| | | | | | | |
Collapse
|
7
|
Chen CI, Cao Y, Trudel S, Reece DE, Kukreti V, Tiedemann R, Prica A, Paul H, Le LW, Levina O, Kakar S, Lau A, Chen H, Chen E. An open-label, pharmacokinetic study of lenalidomide and dexamethasone therapy in previously untreated multiple myeloma (MM) patients with various degrees of renal impairment - validation of official dosing guidelines. Leuk Lymphoma 2020; 61:1860-1868. [PMID: 32476520 DOI: 10.1080/10428194.2020.1747064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Lenalidomide is a backbone agent in the treatment of multiple myeloma, but dose adjustment is required for those with renal impairment (RI). We evaluated the pharmacokinetics (PK) and safety of lenalidomide and dexamethasone as frontline pre-transplant induction, with doses adjusted at start of each cycle based on creatinine clearance, as per the official dosing guidelines. After 4 cycles, PK studies showed that patients with moderate RI (30 ≤ CrCl < 60 mL/min) receiving 10 mg dosing may be under-dosed and those with severe RI (CrCl <30ml/min) appeared appropriately dosed initially, but sustained significant decreases in maximum serum concentration (Cmax) after repeated dosing, due to rapid clinical improvement and enhanced drug clearance. PK drug monitoring during cycle 1 may facilitate appropriate and timely dose adjustments. Adverse events rates did not vary based on severity of RI. No patient discontinued lenalidomide for toxicity. This supports the feasibility and safety of frontline lenalidomide in transplant-eligible patients with RI.
Collapse
Affiliation(s)
- Christine I Chen
- Princess Margaret Cancer Centre, Ontario Cancer Institute, Toronto, Canada
| | - Yanshuo Cao
- Princess Margaret Cancer Centre, Ontario Cancer Institute, Toronto, Canada
| | - Suzanne Trudel
- Princess Margaret Cancer Centre, Ontario Cancer Institute, Toronto, Canada
| | - Donna E Reece
- Princess Margaret Cancer Centre, Ontario Cancer Institute, Toronto, Canada
| | - Vishal Kukreti
- Princess Margaret Cancer Centre, Ontario Cancer Institute, Toronto, Canada
| | - Rodger Tiedemann
- Princess Margaret Cancer Centre, Ontario Cancer Institute, Toronto, Canada
| | - Anca Prica
- Princess Margaret Cancer Centre, Ontario Cancer Institute, Toronto, Canada
| | - Harminder Paul
- Princess Margaret Cancer Centre, Ontario Cancer Institute, Toronto, Canada
| | - Lisa W Le
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Canada
| | - Olga Levina
- Princess Margaret Cancer Centre, Ontario Cancer Institute, Toronto, Canada
| | - Sumeet Kakar
- Princess Margaret Cancer Centre, Ontario Cancer Institute, Toronto, Canada
| | - Anthea Lau
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Canada
| | | | - Eric Chen
- Princess Margaret Cancer Centre, Ontario Cancer Institute, Toronto, Canada
| |
Collapse
|
8
|
Chen J, Liu H, Li L, Liu Z, Song J, Wang G, Wang H, Ruan E, Ding K, Shao Z, Fu R. Clinical features and treatment outcome of elderly multiple myeloma patients with impaired renal function. J Clin Lab Anal 2019; 33:e22888. [PMID: 31004381 PMCID: PMC6595344 DOI: 10.1002/jcla.22888] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 03/10/2019] [Accepted: 03/10/2019] [Indexed: 01/08/2023] Open
Abstract
Background Renal impairment (RI) is a most common complication of multiple myeloma (MM), which is associated with an increased risk of early death and worse survival. Methods We retrospectively analyzed clinical features and outcomes of 77 MM patients over 70 years old and compared the differences between with and without RI groups. Results The percentage of elder MM patients with RI was 61%. Hemoglobin level was a protective factor (OR = 0.954, P = 0.033), while creatinine and hypertension were hazards (OR = 1.288, P < 0.001 and OR = 30.12, P = 0.008). And the percentages of patients with mild‐to‐moderate RI and moderate‐to‐severe RI were 40.4% and 59.6%. Complete remission (CR) rate was higher in patients treated with bortezomib (33.3%) than those with non‐bortezomib treatment (3.33%) (P = 0.007). Meanwhile, CRrenal was higher in patients with bortezomib (58.3%) than non‐bortezomib treatment (22.2%) (P = 0.025). The median OS of the patients with RI treated with bortezomib was longer than those with non‐bortezomib regimens (15.0 vs 6.0 months, P = 0.001). The same result was observed in the patients with moderate‐to‐severe RI (13.0 vs 6.0 months, P = 0.007). The median OS of the patients with RI receiving the bortezomib regimens (15 months) was longer than those with non‐bortezomib regimens (6.0 months) (P = 0.001). Conclusion Hemoglobin is a protective factor in elder patients with RI, while creatinine and hypertension were hazards. The median OS of elderly patients with RI was worse, and bortezomib can improve the CR rate in these patients.
Collapse
Affiliation(s)
- Jin Chen
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin, China
| | - Hui Liu
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin, China
| | - Lijuan Li
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin, China
| | - Zhaoyun Liu
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin, China
| | - Jia Song
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin, China
| | - Guojin Wang
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin, China
| | - Huaquan Wang
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin, China
| | - Erbao Ruan
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin, China
| | - Kai Ding
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin, China
| | - Zonghong Shao
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin, China
| | - Rong Fu
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin, China
| |
Collapse
|
9
|
Gavriatopoulou M, Terpos E, Dimopoulos MA. IMiDs for myeloma induced renal impairment. Oncotarget 2018; 9:35476-35477. [PMID: 30464802 PMCID: PMC6231459 DOI: 10.18632/oncotarget.26270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 10/17/2018] [Indexed: 11/25/2022] Open
Affiliation(s)
- Maria Gavriatopoulou
- Department of Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Evangelos Terpos
- Department of Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Meletios Athanasios Dimopoulos
- Department of Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| |
Collapse
|
10
|
Ying L, YinHui T, Yunliang Z, Sun H. Lenalidomide and the risk of serious infection in patients with multiple myeloma: a systematic review and meta-analysis. Oncotarget 2018; 8:46593-46600. [PMID: 28423741 PMCID: PMC5542295 DOI: 10.18632/oncotarget.16235] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 02/20/2017] [Indexed: 12/30/2022] Open
Abstract
The immunomodulatory drug lenalidomide is highly effective against newly diagnosed and relapsed/refractory multiple myeloma (MM), but serious and even fatal infections have been associated with its use. In this meta-analysis, we assessed the overall risk of infection to MM patients treated with lenalidomide. Eleven phase II or III clinical trials, comprising 3,210 subjects, were selected from the Embase, Pubmed, and Cochrane Library databases, from the Clinical Trial Registration website, and from meeting abstracts and virtual presentations at the American Society of Clinical Oncology. Main outcome measures were overall incidence, relative risk (RR), and 95% confidence intervals (CIs) of reported infection events. Fixed-effect or random-effect models were used in the statistical analyses, depending on the between-study heterogeneity. The overall incidence of high-grade infection was 14.32% (95% CI: 12.08%-16.90%) and high-grade infection's pooled RR was 2.23 (95% CI: 1.71-2.91, P < 0.0001) for all 11 studies evaluated. No evidence of publication bias for the incidence of high-grade infection was detected using Begg's funnel plot and Egger's test (P = 0.2; 95% CI: -1.70, 1.23). From this meta-analysis, it appears lenalidomide use is associated with an increased risk of high-grade infection. Moreover, fatal infection events occurred only in patients treated with lenalidomide; no infection-related deaths were observed among controls. These data indicate that accurate diagnosis and optimal management of infection in MM patients treated with lenalidomide could be critical for treatment efficacy.
Collapse
Affiliation(s)
- Li Ying
- Department of Pharmacy, The First Affiliated Hospital of College of Medicine, Zhejiang University, Hangzhou, P.R.China
| | - Tong YinHui
- Department of Pharmacy, Zhejiang Cancer Hospital, Hangzhou, Hangzhou, P.R.China
| | - Zheng Yunliang
- Research Center for Clinical Pharmacy, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital of College of Medicine, Zhejiang University, Hangzhou, Zhejiang, P.R. China
| | - Haozhen Sun
- Department of Pharmacy, The First Affiliated Hospital of College of Medicine, Zhejiang University, Hangzhou, P.R.China
| |
Collapse
|
11
|
Rekhtina IG, Mendeleeva LP. [Current approaches to treating of patients with multiple myeloma with renal failure: Questions and proofs]. TERAPEVT ARKH 2017; 89:112-117. [PMID: 28766550 DOI: 10.17116/terarkh2017897112-117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Renal failure (RF) is detected in 20-30% of patients at the onset of multiple myeloma (MM), in 50% of patients during its progression. The advent of new, highly effective agents has considerably expanded the possibilities of treatment in MM patients. Unfortunately, patients with RF, especially those with severe RF, were not included in the majority of investigations. The available data are based on the results of treatment in small groups of patients generally without the morphological identification of nephropathies, with varying severity of RF, which explains significant differences in renal response rates. This review analyzes the results of the most important studies and gives recommendations for treatment in accordance with national and international standards.
Collapse
Affiliation(s)
- I G Rekhtina
- National Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia
| | - L P Mendeleeva
- National Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia
| |
Collapse
|
12
|
de Vries JC, Oortgiesen B, Hemmelder MH, van Roon E, Kibbelaar RE, Veeger N, Hoogendoorn M. Restoration of renal function in patients with newly diagnosed multiple myeloma is not associated with improved survival: a population-based study. Leuk Lymphoma 2017; 58:1-9. [DOI: 10.1080/10428194.2016.1277385] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Joost C. de Vries
- Department of Hematology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Berdien Oortgiesen
- Department of Clinical Pharmacy & Pharmacology, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Marc H. Hemmelder
- Department of Nephrology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Eric van Roon
- Department of Clinical Pharmacy & Pharmacology, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Robby E. Kibbelaar
- Department of Pathology, Pathology Friesland, Leeuwarden, The Netherlands
| | - Nic Veeger
- Department of Epidemiology, MCL Academy, Leeuwarden, The Netherlands
| | - Mels Hoogendoorn
- Department of Hematology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| |
Collapse
|
13
|
Gavriatopoulou M, Terpos E, Kastritis E, Dimopoulos MA. Current treatments for renal failure due to multiple myeloma. Expert Opin Pharmacother 2016; 17:2165-2177. [PMID: 27646819 DOI: 10.1080/14656566.2016.1236915] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Renal impairment (RI) is one of the most common complication of multiple myeloma (MM). RI is present in almost 20% of MM patients at diagnosis and in 40%-50% of patients during the course of their disease. Areas covered: Biology along with tools for diagnosis and management of RI are reported in this paper. Papers published in PubMed and reported abstracts up to May 2016 were used. Expert opinion: Moderate and severe RI increases the risk of early death; thus rapid intervention and initiation of anti-myeloma treatment is essential and improves renal outcomes in RI patients. Bortezomib and dexamethasone triplet combinations are the current standard of therapy for MM patients with acute kidney injury due to cast nephropathy; they offer high rates of both anti-myeloma response and renal recovery. Thalidomide and lenalidomide may be used in bortezomib refractory patients. In the relapsed/refractory setting additional treatment options such as carfilzomib, pomalidomide and monoclonal antibodies are available; however, there is limited data for their effects on patients with RI. High dose melphalan with autologous stem cell transplantation should be considered in otherwise eligible patients with RI. Finally, high cut-off hemodialysis membranes do not seem to offer significant additive effects on anti-myeloma therapies.
Collapse
Affiliation(s)
- Maria Gavriatopoulou
- a Department of Clinical Therapeutics, School of Medicine , National and Kapodistrian University of Athens , Athens , Greece
| | - Evangelos Terpos
- a Department of Clinical Therapeutics, School of Medicine , National and Kapodistrian University of Athens , Athens , Greece
| | - Efstathios Kastritis
- a Department of Clinical Therapeutics, School of Medicine , National and Kapodistrian University of Athens , Athens , Greece
| | - Meletios A Dimopoulos
- a Department of Clinical Therapeutics, School of Medicine , National and Kapodistrian University of Athens , Athens , Greece
| |
Collapse
|
14
|
Hogan JJ, Weiss BM. Bridging the Divide: An Onco-Nephrologic Approach to the Monoclonal Gammopathies of Renal Significance. Clin J Am Soc Nephrol 2016; 11:1681-1691. [PMID: 27416775 PMCID: PMC5012477 DOI: 10.2215/cjn.03160316] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The monoclonal gammopathies of renal significance (MGRS) are a group of disorders characterized by monoclonal Ig deposition in the kidney, but are not associated with systemic lymphoma or overt multiple myeloma. The prevailing hypothesis is that the pathogenic paraproteins in MGRS are produced by underlying B cell or plasma cell clones. However, in the MGRS literature, the yield of detecting a clone has been variable, and progression to ESRD is common. Here, we present an "onco-nephrologic" approach to the MGRS disorders by highlighting recent advances in lymphoma and multiple myeloma that can be used in the evaluation and management of these patients.
Collapse
Affiliation(s)
| | - Brendan M Weiss
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| |
Collapse
|
15
|
Abstract
INTRODUCTION About 20-40% of patients with multiple myeloma (MM) will present with some degree of renal impairment (RI) and about 25% of patients will experience RI at later disease stages. Patients with MM and RI have poorer overall survival and are at higher risk of early death. AREAS COVERED The mechanisms of acute renal damage in MM are covered and the issues around diagnosis and renal evaluation response are discussed. The importance of optimal supportive care is stressed and the role and effectiveness of different anti-myeloma agents covered including the role of high cut-off hemodialysis, autologous stem cell transplantation and kidney transplant. Expert commentary: Outcomes of patients with RI and rates of renal recovery have improved with the use of novel anti-myeloma agents. Bortezomib-dexamethasone backbone regimes (±third agent) are the current first choice in newly diagnosed patients. In relapsed/refractory disease additional treatment options include newer novel agents.
Collapse
Affiliation(s)
- Despoina Fotiou
- a Department of Clinical Therapeutics , National and Kapodistrian University of Athens, School of Medicine , Athens , Greece
| | - Meletios A Dimopoulos
- a Department of Clinical Therapeutics , National and Kapodistrian University of Athens, School of Medicine , Athens , Greece
| | - Efstathios Kastritis
- a Department of Clinical Therapeutics , National and Kapodistrian University of Athens, School of Medicine , Athens , Greece
| |
Collapse
|
16
|
Dimopoulos MA, Roussou M, Gavriatopoulou M, Psimenou E, Eleutherakis-Papaiakovou E, Migkou M, Matsouka C, Mparmparousi D, Gika D, Kafantari E, Ziogas D, Fotiou D, Panagiotidis I, Terpos E, Kastritis E. Bortezomib-based triplets are associated with a high probability of dialysis independence and rapid renal recovery in newly diagnosed myeloma patients with severe renal failure or those requiring dialysis. Am J Hematol 2016; 91:499-502. [PMID: 26890495 DOI: 10.1002/ajh.24335] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 02/10/2016] [Accepted: 02/13/2016] [Indexed: 11/07/2022]
Abstract
Renal failure (RF) is a common and severe complication of symptomatic myeloma, associated with significant morbidity and mortality. Such patients are commonly excluded from clinical trials. Bortezomib/dexamethasone (VD)-based regimens are the backbone of the treatment of newly diagnosed MM patients who present with severe RF even those requiring dialysis. We analyzed the outcomes of 83 consecutive bortezomib-treated patients with severe RF (eGFR < 30 ml/min/1.73 m(2) ), of which 31 (37%) required dialysis. By IMWG renal response criteria, 54 (65%) patients achieved at least MRrenal, including CRrenal in 35% and PRrenal in 12%. Triplet combinations (i.e., VD plus a third agent) versus VD alone were associated with higher rates of renal responses (72 vs. 50%; P = 0.06). Fifteen of the 31 (48%) patients became dialysis independent within a median of 217 days (range 11-724). Triplets were associated with a higher probability of dialysis discontinuation (57 vs. 35%). Serum free light chain (sFLC) level ≥11,550 mg/L was associated with lower rates of major renal response, longer time to major renal response, lower probability, and longer time to dialysis discontinuation. Rapid myeloma response (≥PR within the first month) was also associated with higher rates of renal response. Patients who became dialysis-independent had longer survival than those remaining on dialysis. In conclusion, VD-based triplets are associated with a significant probability of renal response and dialysis discontinuation, improving the survival of patients who became dialysis independent. Rapid disease response is important for renal recovery and sFLCs are predictive of the probability and of the time required for renal response.
Collapse
Affiliation(s)
- Meletios A. Dimopoulos
- Department of Clinical Therapeutics; National and Kapodistrian University of Athens, School of Medicine; Athens Greece
| | - Maria Roussou
- Department of Clinical Therapeutics; National and Kapodistrian University of Athens, School of Medicine; Athens Greece
| | - Maria Gavriatopoulou
- Department of Clinical Therapeutics; National and Kapodistrian University of Athens, School of Medicine; Athens Greece
| | - Erasmia Psimenou
- Department of Clinical Therapeutics; National and Kapodistrian University of Athens, School of Medicine; Athens Greece
| | | | - Magdalini Migkou
- Department of Clinical Therapeutics; National and Kapodistrian University of Athens, School of Medicine; Athens Greece
| | - Charis Matsouka
- Department of Clinical Therapeutics; National and Kapodistrian University of Athens, School of Medicine; Athens Greece
| | - Despoina Mparmparousi
- Department of Clinical Therapeutics; National and Kapodistrian University of Athens, School of Medicine; Athens Greece
| | - Dimitra Gika
- Department of Clinical Therapeutics; National and Kapodistrian University of Athens, School of Medicine; Athens Greece
| | - Eftychia Kafantari
- Department of Clinical Therapeutics; National and Kapodistrian University of Athens, School of Medicine; Athens Greece
| | - Dimitrios Ziogas
- Department of Clinical Therapeutics; National and Kapodistrian University of Athens, School of Medicine; Athens Greece
| | - Despoina Fotiou
- Department of Clinical Therapeutics; National and Kapodistrian University of Athens, School of Medicine; Athens Greece
| | - Ioannis Panagiotidis
- Department of Clinical Therapeutics; National and Kapodistrian University of Athens, School of Medicine; Athens Greece
| | - Evangelos Terpos
- Department of Clinical Therapeutics; National and Kapodistrian University of Athens, School of Medicine; Athens Greece
| | - Efstathios Kastritis
- Department of Clinical Therapeutics; National and Kapodistrian University of Athens, School of Medicine; Athens Greece
| |
Collapse
|
17
|
Dimopoulos MA, Sonneveld P, Leung N, Merlini G, Ludwig H, Kastritis E, Goldschmidt H, Joshua D, Orlowski RZ, Powles R, Vesole DH, Garderet L, Einsele H, Palumbo A, Cavo M, Richardson PG, Moreau P, San Miguel J, Rajkumar SV, Durie BG, Terpos E. International Myeloma Working Group Recommendations for the Diagnosis and Management of Myeloma-Related Renal Impairment. J Clin Oncol 2016; 34:1544-57. [DOI: 10.1200/jco.2015.65.0044] [Citation(s) in RCA: 221] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose The aim of the International Myeloma Working Group was to develop practical recommendations for the diagnosis and management of multiple myeloma–related renal impairment (RI). Methods Recommendations were based on published data through December 2015, and were developed using the system developed by the Grading of Recommendation, Assessment, Development, and Evaluation Working Group. Recommendations All patients with myeloma at diagnosis and at disease assessment should have serum creatinine, estimated glomerular filtration rate, and electrolytes measurements as well as free light chain, if available, and urine electrophoresis of a sample from a 24-hour urine collection (grade A). The Chronic Kidney Disease Epidemiology Collaboration, preferably, or the Modification of Diet in Renal Disease formula should be used for the evaluation of estimated glomerular filtration rate in patients with stabilized serum creatinine (grade A). International Myeloma Working Group criteria for renal reversibility should be used (grade B). For the management of RI in patients with multiple myeloma, high fluid intake is indicated along with antimyeloma therapy (grade B). The use of high-cutoff hemodialysis membranes in combination with antimyeloma therapy can be considered (grade B). Bortezomib-based regimens remain the cornerstone of the management of myeloma-related RI (grade A). High-dose dexamethasone should be administered at least for the first month of therapy (grade B). Thalidomide is effective in patients with myeloma with RI, and no dose modifications are needed (grade B). Lenalidomide is effective and safe, mainly in patients with mild to moderate RI (grade B); for patients with severe RI or on dialysis, lenalidomide should be given with close monitoring for hematologic toxicity (grade B) with dose reduction as needed. High-dose therapy with autologous stem cell transplantation (with melphalan 100 mg/m2 to 140 mg/m2) is feasible in patients with RI (grade C). Carfilzomib can be safely administered to patients with creatinine clearance > 15 mL/min, whereas ixazomib in combination with lenalidomide and dexamethasone can be safely administered to patients with creatinine clearance > 30 mL/min (grade A).
Collapse
Affiliation(s)
- Meletios A. Dimopoulos
- Meletios A. Dimopoulos, Efstathios Kastritis, and Evangelos Terpos, National and Kapodistrian University of Athens, Athens, Greece; Pieter Sonneveld, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Nelson Leung and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Robert Z. Orlowski, The University of Texas MD Anderson Cancer Center, Houston, TX; David H. Vesole, Hackensack University Medical Center, Hackensack, NJ; Paul G. Richardson, Dana-Farber Cancer Institute, Boston, MA
| | - Pieter Sonneveld
- Meletios A. Dimopoulos, Efstathios Kastritis, and Evangelos Terpos, National and Kapodistrian University of Athens, Athens, Greece; Pieter Sonneveld, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Nelson Leung and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Robert Z. Orlowski, The University of Texas MD Anderson Cancer Center, Houston, TX; David H. Vesole, Hackensack University Medical Center, Hackensack, NJ; Paul G. Richardson, Dana-Farber Cancer Institute, Boston, MA
| | - Nelson Leung
- Meletios A. Dimopoulos, Efstathios Kastritis, and Evangelos Terpos, National and Kapodistrian University of Athens, Athens, Greece; Pieter Sonneveld, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Nelson Leung and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Robert Z. Orlowski, The University of Texas MD Anderson Cancer Center, Houston, TX; David H. Vesole, Hackensack University Medical Center, Hackensack, NJ; Paul G. Richardson, Dana-Farber Cancer Institute, Boston, MA
| | - Giampaolo Merlini
- Meletios A. Dimopoulos, Efstathios Kastritis, and Evangelos Terpos, National and Kapodistrian University of Athens, Athens, Greece; Pieter Sonneveld, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Nelson Leung and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Robert Z. Orlowski, The University of Texas MD Anderson Cancer Center, Houston, TX; David H. Vesole, Hackensack University Medical Center, Hackensack, NJ; Paul G. Richardson, Dana-Farber Cancer Institute, Boston, MA
| | - Heinz Ludwig
- Meletios A. Dimopoulos, Efstathios Kastritis, and Evangelos Terpos, National and Kapodistrian University of Athens, Athens, Greece; Pieter Sonneveld, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Nelson Leung and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Robert Z. Orlowski, The University of Texas MD Anderson Cancer Center, Houston, TX; David H. Vesole, Hackensack University Medical Center, Hackensack, NJ; Paul G. Richardson, Dana-Farber Cancer Institute, Boston, MA
| | - Efstathios Kastritis
- Meletios A. Dimopoulos, Efstathios Kastritis, and Evangelos Terpos, National and Kapodistrian University of Athens, Athens, Greece; Pieter Sonneveld, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Nelson Leung and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Robert Z. Orlowski, The University of Texas MD Anderson Cancer Center, Houston, TX; David H. Vesole, Hackensack University Medical Center, Hackensack, NJ; Paul G. Richardson, Dana-Farber Cancer Institute, Boston, MA
| | - Hartmut Goldschmidt
- Meletios A. Dimopoulos, Efstathios Kastritis, and Evangelos Terpos, National and Kapodistrian University of Athens, Athens, Greece; Pieter Sonneveld, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Nelson Leung and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Robert Z. Orlowski, The University of Texas MD Anderson Cancer Center, Houston, TX; David H. Vesole, Hackensack University Medical Center, Hackensack, NJ; Paul G. Richardson, Dana-Farber Cancer Institute, Boston, MA
| | - Douglas Joshua
- Meletios A. Dimopoulos, Efstathios Kastritis, and Evangelos Terpos, National and Kapodistrian University of Athens, Athens, Greece; Pieter Sonneveld, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Nelson Leung and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Robert Z. Orlowski, The University of Texas MD Anderson Cancer Center, Houston, TX; David H. Vesole, Hackensack University Medical Center, Hackensack, NJ; Paul G. Richardson, Dana-Farber Cancer Institute, Boston, MA
| | - Robert Z. Orlowski
- Meletios A. Dimopoulos, Efstathios Kastritis, and Evangelos Terpos, National and Kapodistrian University of Athens, Athens, Greece; Pieter Sonneveld, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Nelson Leung and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Robert Z. Orlowski, The University of Texas MD Anderson Cancer Center, Houston, TX; David H. Vesole, Hackensack University Medical Center, Hackensack, NJ; Paul G. Richardson, Dana-Farber Cancer Institute, Boston, MA
| | - Raymond Powles
- Meletios A. Dimopoulos, Efstathios Kastritis, and Evangelos Terpos, National and Kapodistrian University of Athens, Athens, Greece; Pieter Sonneveld, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Nelson Leung and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Robert Z. Orlowski, The University of Texas MD Anderson Cancer Center, Houston, TX; David H. Vesole, Hackensack University Medical Center, Hackensack, NJ; Paul G. Richardson, Dana-Farber Cancer Institute, Boston, MA
| | - David H. Vesole
- Meletios A. Dimopoulos, Efstathios Kastritis, and Evangelos Terpos, National and Kapodistrian University of Athens, Athens, Greece; Pieter Sonneveld, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Nelson Leung and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Robert Z. Orlowski, The University of Texas MD Anderson Cancer Center, Houston, TX; David H. Vesole, Hackensack University Medical Center, Hackensack, NJ; Paul G. Richardson, Dana-Farber Cancer Institute, Boston, MA
| | - Laurent Garderet
- Meletios A. Dimopoulos, Efstathios Kastritis, and Evangelos Terpos, National and Kapodistrian University of Athens, Athens, Greece; Pieter Sonneveld, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Nelson Leung and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Robert Z. Orlowski, The University of Texas MD Anderson Cancer Center, Houston, TX; David H. Vesole, Hackensack University Medical Center, Hackensack, NJ; Paul G. Richardson, Dana-Farber Cancer Institute, Boston, MA
| | - Hermann Einsele
- Meletios A. Dimopoulos, Efstathios Kastritis, and Evangelos Terpos, National and Kapodistrian University of Athens, Athens, Greece; Pieter Sonneveld, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Nelson Leung and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Robert Z. Orlowski, The University of Texas MD Anderson Cancer Center, Houston, TX; David H. Vesole, Hackensack University Medical Center, Hackensack, NJ; Paul G. Richardson, Dana-Farber Cancer Institute, Boston, MA
| | - Antonio Palumbo
- Meletios A. Dimopoulos, Efstathios Kastritis, and Evangelos Terpos, National and Kapodistrian University of Athens, Athens, Greece; Pieter Sonneveld, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Nelson Leung and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Robert Z. Orlowski, The University of Texas MD Anderson Cancer Center, Houston, TX; David H. Vesole, Hackensack University Medical Center, Hackensack, NJ; Paul G. Richardson, Dana-Farber Cancer Institute, Boston, MA
| | - Michele Cavo
- Meletios A. Dimopoulos, Efstathios Kastritis, and Evangelos Terpos, National and Kapodistrian University of Athens, Athens, Greece; Pieter Sonneveld, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Nelson Leung and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Robert Z. Orlowski, The University of Texas MD Anderson Cancer Center, Houston, TX; David H. Vesole, Hackensack University Medical Center, Hackensack, NJ; Paul G. Richardson, Dana-Farber Cancer Institute, Boston, MA
| | - Paul G. Richardson
- Meletios A. Dimopoulos, Efstathios Kastritis, and Evangelos Terpos, National and Kapodistrian University of Athens, Athens, Greece; Pieter Sonneveld, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Nelson Leung and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Robert Z. Orlowski, The University of Texas MD Anderson Cancer Center, Houston, TX; David H. Vesole, Hackensack University Medical Center, Hackensack, NJ; Paul G. Richardson, Dana-Farber Cancer Institute, Boston, MA
| | - Philippe Moreau
- Meletios A. Dimopoulos, Efstathios Kastritis, and Evangelos Terpos, National and Kapodistrian University of Athens, Athens, Greece; Pieter Sonneveld, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Nelson Leung and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Robert Z. Orlowski, The University of Texas MD Anderson Cancer Center, Houston, TX; David H. Vesole, Hackensack University Medical Center, Hackensack, NJ; Paul G. Richardson, Dana-Farber Cancer Institute, Boston, MA
| | - Jesús San Miguel
- Meletios A. Dimopoulos, Efstathios Kastritis, and Evangelos Terpos, National and Kapodistrian University of Athens, Athens, Greece; Pieter Sonneveld, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Nelson Leung and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Robert Z. Orlowski, The University of Texas MD Anderson Cancer Center, Houston, TX; David H. Vesole, Hackensack University Medical Center, Hackensack, NJ; Paul G. Richardson, Dana-Farber Cancer Institute, Boston, MA
| | - S. Vincent Rajkumar
- Meletios A. Dimopoulos, Efstathios Kastritis, and Evangelos Terpos, National and Kapodistrian University of Athens, Athens, Greece; Pieter Sonneveld, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Nelson Leung and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Robert Z. Orlowski, The University of Texas MD Anderson Cancer Center, Houston, TX; David H. Vesole, Hackensack University Medical Center, Hackensack, NJ; Paul G. Richardson, Dana-Farber Cancer Institute, Boston, MA
| | - Brian G.M. Durie
- Meletios A. Dimopoulos, Efstathios Kastritis, and Evangelos Terpos, National and Kapodistrian University of Athens, Athens, Greece; Pieter Sonneveld, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Nelson Leung and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Robert Z. Orlowski, The University of Texas MD Anderson Cancer Center, Houston, TX; David H. Vesole, Hackensack University Medical Center, Hackensack, NJ; Paul G. Richardson, Dana-Farber Cancer Institute, Boston, MA
| | - Evangelos Terpos
- Meletios A. Dimopoulos, Efstathios Kastritis, and Evangelos Terpos, National and Kapodistrian University of Athens, Athens, Greece; Pieter Sonneveld, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Nelson Leung and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Robert Z. Orlowski, The University of Texas MD Anderson Cancer Center, Houston, TX; David H. Vesole, Hackensack University Medical Center, Hackensack, NJ; Paul G. Richardson, Dana-Farber Cancer Institute, Boston, MA
| |
Collapse
|
18
|
Yadav P, Cook M, Cockwell P. Current Trends of Renal Impairment in Multiple Myeloma. KIDNEY DISEASES 2016; 1:241-57. [PMID: 27536684 DOI: 10.1159/000442511] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 11/18/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND Renal impairment (RI) is a common complication of multiple myeloma (MM). Around 50% of patients with MM have RI at presentation, and up to 5% require dialysis treatment. Severe acute kidney injury (AKI) as a cause of RI is a particular challenge as historically the survival of patients who sustain this complication and require dialysis is very poor. However, in this current period, survival is improving and the focus is on optimum use of novel chemotherapies and the evaluation of extra-corporeal therapies for removal of serum immunoglobulin light chains. SUMMARY RI in patients with MM is commonly associated with excess monoclonal free light chain (FLC) production; myeloma cast nephropathy is the predominant renal pathology in patients presenting with severe RI secondary to AKI. The majority of patients have mild to moderate RI and recover renal function. However, patients with more severe RI, in particular those with a requirement for dialysis, are less likely to recover renal function. Rapid diagnosis and prompt institution of anti-myeloma therapy is an important determinant of renal function recovery, through targeting early and sustained reduction of involved monoclonal FLC. Novel agents are associated with excellent disease response, and bortezomib is now widely used as a first-line agent in the management of MM in patients with severe RI. Extended haemodialysis using high cut-off dialysers is more effective for extracorporeal removal of FLC than plasma exchange, and clinical trials are in process. High-dose chemotherapy with autologous stem cell transplantation does have a role in patients with severe RI but requires careful patient selection. KEY MESSAGES RI is very common in patients with MM, and renal function recovery is associated with improved clinical outcomes. We summarise the epidemiology of MM in the UK, present the impact of RI and renal function recovery on patient outcome, and describe the current management of MM in western countries. FACTS FROM EAST AND WEST (1) A serum creatinine level >2 mg/dl has been reported in 16, 21, 24, and 33% of patients with MM in cohort studies from Japan, Europe, China, and Korea, respectively. A creatinine clearance rate <30 ml/min was observed in 30 and 15% of patients in Chinese and Western MM cohorts, respectively. The commonest cause of severe RI in patients with MM is myeloma cast nephropathy. (2) The efficacy of novel treatments (bortezomib, carfilzomib, thalidomide, and lenalidomide) has predominantly been assessed in Western patients. Bortezomib and dexamethasone are the current standard of care for MM and severe RI in the West. Severe RI is not a contraindication to autologous stem cell transplantation (ASCT). Most of the data are from the West; there are case reports from China describing good outcomes with ASCT. The removal of FLC by high-cut-off hemodialysis is under evaluation in randomized controlled trials (RCTs) in the West. Studies in this area are not yet conducted in China. In China, new treatments, such as bortezomib, are more widely used than before, and favorable results are being reported; however, RCT studies are still needed in this area to confirm the efficacy and safety of this and other novel treatments.
Collapse
Affiliation(s)
- Punit Yadav
- Department of Renal Medicine, Queen Elizabeth Hospital, Birmingham, UK; School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK; Birmingham Institute of Translational Medicine, Birmingham, UK
| | - Mark Cook
- Birmingham Institute of Translational Medicine, Birmingham, UK; Department of Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | - Paul Cockwell
- Department of Renal Medicine, Queen Elizabeth Hospital, Birmingham, UK; School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK; Birmingham Institute of Translational Medicine, Birmingham, UK
| |
Collapse
|
19
|
Yadav P, Hutchison CA, Basnayake K, Stringer S, Jesky M, Fifer L, Snell K, Pinney J, Drayson MT, Cook M, Cockwell P. Patients with multiple myeloma have excellent long-term outcomes after recovery from dialysis-dependent acute kidney injury. Eur J Haematol 2015; 96:610-7. [PMID: 26248588 DOI: 10.1111/ejh.12644] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of this study was to report the long-term outcomes in patients with multiple myeloma (MM) who receive dialysis treatment for acute kidney injury (AKI) due to myeloma cast nephropathy and subsequently recover renal function. METHODS Patients presenting with dialysis-dependent AKI secondary to myeloma cast nephropathy and subsequently recovering independent renal function between January 2005 and December 2012 were included in this study. Both renal and haematological parameters were collected at multiple time points as part of routine clinic practice. Factors associated with renal function and overall survival (OS) were determined. RESULTS Twenty-four patients fulfilled the criteria for inclusion. Mean age was 62.1 years; 75% were male and 75% were of White ethnicity. The median OS was 64.1 months (95% confidence interval [CI] 34.8-93.3). Twenty-three (95.8%) patients remained dialysis-independent until death or end of follow-up; one patient required further haemodialysis treatment during the follow-up period. The independent determinant of worse OS was a known history of chronic kidney disease (CKD) at presentation. Shorter length of time on haemodialysis and higher percentage reduction in clonal serum FLC at day 21 from baseline predicted better excretory renal function (estimated glomerular filtration rate) at 6 months. CONCLUSION In this series, the large majority of patients with MM and dialysis-dependent AKI secondary to myeloma cast nephropathy who recovered independent renal function had no requirement for further dialysis. Survival following recovery of renal function is good, and early variables are independently associated with survival and future renal function.
Collapse
Affiliation(s)
- Punit Yadav
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Colin A Hutchison
- Department of Medicine, Hawke's Bay District Health Board, Hastings, New Zealand
| | - Kolitha Basnayake
- Department of Renal Medicine, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Stephanie Stringer
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Mark Jesky
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Lesley Fifer
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Kym Snell
- Department of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Jennifer Pinney
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Mark T Drayson
- Division of Immunity and Infection, University of Birmingham, Birmingham, UK
| | - Mark Cook
- Department of Haematology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Paul Cockwell
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| |
Collapse
|
20
|
Cejalvo MJ, de la Rubia J. Front-line lenalidomide therapy in patients with newly diagnosed multiple myeloma. Future Oncol 2015; 11:1643-58. [PMID: 25857329 DOI: 10.2217/fon.15.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The availability of novel drugs with different and innovative mechanisms of action such as proteasome inhibitors such as bortezomib and immunomdulatory agents as thalidomide and lenalidomide have changed the landscape of the treatment of patients with newly diagnosed multiple myeloma, allowing the development of several new therapeutic regimens both for transplant-eligible and -ineligible patients. Among these new agents, lenalidomide has become one of the most commonly used in these patients. In this article, we review the current state-of-the-art of different induction and maintenance lenalidomide-containing regimens administered in transplant-eligible and -ineligible patients with newly diagnosed multiple myeloma. We also discuss the safety profile and potential long-term side effects of this drug and analyze its utility in certain subgroups of patients like those with high-risk disease or different degrees of renal impairment.
Collapse
Affiliation(s)
- María J Cejalvo
- 1Hematology Service, University Hospital Doctor Peset, Avda Gaspar Aguilar 90, 46017 Valencia, Spain
| | - Javier de la Rubia
- 1Hematology Service, University Hospital Doctor Peset, Avda Gaspar Aguilar 90, 46017 Valencia, Spain.,2Universidad Católica de Valencia 'San Vicente Mártir', Valencia, Spain
| |
Collapse
|