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Sharma R, Jain A, Jandial A, Lad D, Khadwal A, Prakash G, Nada R, Aggarwal R, Ramachandran R, Varma N, Malhotra P. Lack of Renal Recovery Predicts Poor Survival in Patients of Multiple Myeloma With Renal Impairment. Clin Lymphoma Myeloma Leuk 2022; 22:626-634. [PMID: 35610119 DOI: 10.1016/j.clml.2022.04.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/04/2022] [Accepted: 04/10/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Renal impairment (RI) confers a poor prognosis in multiple myeloma. Reversibility of renal function is associated with improved survival in such patients. Patients in developing countries often present at an advanced stage and renal impairment is present in up to 40% of patients at diagnosis. We studied the renal outcome and survival of these patients with bortezomib-based induction therapy. MATERIALS AND METHODS It was a single-center prospective study in a tertiary care multi-specialty institute in patients of newly diagnosed multiple myeloma (NDMM) who presented with RI from July 2018 to December 2019. The diagnosis of multiple myeloma was made based on IMWG14 criteria. All patients received bortezomib and or immunomodulatory drug-based triplet or quadruplet induction therapy. Hematological and renal outcomes were assessed as per IMWG 2016 criteria. RESULTS Among 216 consecutive patients of NDMM, RI was seen in 91 (42.2%) patients. The median age of 91 patients was 60 years. (range- 32-80 years). Light chain myeloma was seen in 26% (n = 24) of patients. The median estimated glomerular filtration rate (eGFR) was 15.36 mL/min (3.1-38 mL/min) and a majority of patients were in the advanced ISS stage. (ISS III = 85.7%). Thirty-six (39.5%) patients received hemodialysis at presentation. Renal response was seen in 67 (73%) patients and 20 (out of 36; 55%) became dialysis independent over a median time of 38 days (Range 15-160 days). At a median follow-up of 14.7 months, 30 (33%) patients had died, of which, 14 (15.4%) patients had early mortality (within 2 months of diagnosis). Presence of light chain myeloma and cast nephropathy (definite or probable) were identified as independent predictors of poor renal recovery on multivariate analysis. (HR = 2.841; 95% CI [1.471-5.486], P = .002 for light chain myeloma; HR = 1.859; 95% CI (1.087-3.180); P = .024 for cast nephropathy) Patients with low eGFR at presentation (<12.5 mL/min) were more likely to have persistent renal insufficiency. (HR-3.521; 95% CI (1.856-6.679), P = .000). Patients who attained sustained renal recovery had improved survival as compared to patients in whom renal function failed to improve. (median OS- not reached vs. 8.3 months, P = .000) Achievement of hematological response and independence from hemodialysis was associated with improved survival on multivariate analysis. CONCLUSION Renal impairment was reversible in almost three-fourths of NDMM patients. achievement of hematological response and hemodialysis independence were independent predictors of improved overall survival in NDMM patients with RI.
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Affiliation(s)
- Rintu Sharma
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Arihant Jain
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Aditya Jandial
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Deepesh Lad
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Alka Khadwal
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Gaurav Prakash
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Ritambhra Nada
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Ritu Aggarwal
- Department of Immunopathology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Raja Ramachandran
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Neelam Varma
- Departement of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Pankaj Malhotra
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
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George LL, Malik MN, Miller EJ, Hicks K, Khanam R, Saterehaseman A, McNichol M, Anwer F. Special Considerations for Supportive Care and Management of Complications in Elderly Patients With Multiple Myeloma. Clin Lymphoma Myeloma Leuk 2021:S2152-2650(21)00284-6. [PMID: 34384735 DOI: 10.1016/j.clml.2021.07.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 06/28/2021] [Accepted: 07/12/2021] [Indexed: 12/21/2022]
Abstract
Multiple myeloma is a progressive and incurable hematologic malignancy. It is predominantly a disease of older individuals, with a third of these patients considered to be elderly. In recent years, there has been a focus and emphasis on identifying and stratifying patients based on their functional status and frailty. There are several hallmark complications of the disease-hypercalcemia, renal insufficiency, anemia, bone pain-along with thromboembolism and compromised immunity that are common in patients with multiple myeloma. Due to the wide range of patient ages and functional status, there are, accordingly, different considerations for management of the above complications based on numerous factors, including frailty status. This review focuses on considerations and management of common complications of multiple myeloma in elderly patients. These include renal failure, skeletal complications, anemia, thromboembolism, and infectious complications.
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3
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Chen X, Luo X, Zu Y, Issa HA, Li L, Ye H, Yang T, Hu J, Wei L. Severe renal impairment as an adverse prognostic factor for survival in newly diagnosed multiple myeloma patients. J Clin Lab Anal 2020; 34:e23416. [PMID: 32710448 PMCID: PMC7521223 DOI: 10.1002/jcla.23416] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/05/2020] [Accepted: 05/11/2020] [Indexed: 12/22/2022] Open
Abstract
Background Renal impairment (RI) is associated with poor survival in newly diagnosed multiple myeloma (MM) patients. Renal function recovery has been one of the main therapeutic goals in those patients. Methods The records from 393 newly diagnosed MM patients in our hospital between January 2012 and December 2016 were retrospectively analyzed. RI was defined as an eGFR < 40 mL/min according to the novel IMWG criteria. RI patients were categorized based on their renal function at diagnosis: severe RI: eGFR < 30 mL/min, and mild RI: 30 mL/min ≤ eGFR <40 mL/min. We explored whether RI, and particularly severe RI, was an adverse prognostic factor for survival, and investigated the impact of renal function recovery on survival. Results Severe RI, hemoglobin <100 g/L, LDH ≥ 245 U/L, hyperuricemia, 1q21 amplification, and lack of novel agent treatment were associated with decreased overall survival (OS). Severe RI patients with renal response had a median OS of 27 months compared with 18 months for those patients without renal response (P = .030), but their median OS was still significantly lower than that for patients without severe RI, which was 51 months. In severe RI patients, the overall renal response rate in bortezomib‐based regimens was significantly higher than that in nonbortezomib‐based regimens. Conclusion Our results suggest that severe RI is an adverse prognostic factor for survival in newly diagnosed MM patients, restoration of renal function may improve survival, and bortezomib‐based regimens may be the preferred treatment in patients with severe RI.
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Affiliation(s)
- Xuduan Chen
- Department of Nephrology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xiaofeng Luo
- Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yanping Zu
- Department of Nephrology, Fujian Provincial Hospital Jinshan Branch, Fuzhou, China
| | - Hajji Ally Issa
- Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Linlin Li
- Department of Nephrology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Hong Ye
- Department of Nephrology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Ting Yang
- Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jianda Hu
- Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Lixin Wei
- Department of Nephrology, Fujian Medical University Union Hospital, Fuzhou, China
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Royal V, Leung N, Troyanov S, Nasr SH, Écotière L, LeBlanc R, Adam BA, Angioi A, Alexander MP, Asunis AM, Barreca A, Bianco P, Cohen C, Drosou ME, Fatima H, Fenoglio R, Gougeon F, Goujon JM, Herrera GA, Knebelmann B, Lepori N, Maletta F, Manso R, Motwani SS, Pani A, Rabant M, Rennke HG, Rocatello D, Rosenblum F, Sanders PW, Santos A, Soto K, Sis B, Touchard G, Venner CP, Bridoux F. Clinicopathologic predictors of renal outcomes in light chain cast nephropathy: a multicenter retrospective study. Blood 2020; 135:1833-1846. [PMID: 32160635 PMCID: PMC7243151 DOI: 10.1182/blood.2019003807] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 02/26/2020] [Indexed: 01/15/2023] Open
Abstract
Light chain cast nephropathy (LCCN) in multiple myeloma often leads to severe and poorly reversible acute kidney injury. Severe renal impairment influences the allocation of chemotherapy and its tolerability; it also affects patient survival. Whether renal biopsy findings add to the clinical assessment in predicting renal and patient outcomes in LCCN is uncertain. We retrospectively reviewed clinical presentation, chemotherapy regimens, hematologic response, and renal and patient outcomes in 178 patients with biopsy-proven LCCN from 10 centers in Europe and North America. A detailed pathology review, including assessment of the extent of cast formation, was performed to study correlations with initial presentation and outcomes. Patients presented with a mean estimated glomerular filtration rate (eGFR) of 13 ± 11 mL/min/1.73 m2, and 82% had stage 3 acute kidney injury. The mean number of casts was 3.2/mm2 in the cortex. Tubulointerstitial lesions were frequent: acute tubular injury (94%), tubulitis (82%), tubular rupture (62%), giant cell reaction (60%), and cortical and medullary inflammation (95% and 75%, respectively). Medullary inflammation, giant cell reaction, and the extent of cast formation correlated with eGFR value at LCCN diagnosis. During a median follow-up of 22 months, mean eGFR increased to 43 ± 30 mL/min/1.73 m2. Age, β2-microglobulin, best hematologic response, number of cortical casts per square millimeter, and degree of interstitial fibrosis/tubular atrophy (IFTA) were independently associated with a higher eGFR during follow-up. This eGFR value correlated with overall survival, independently of the hematologic response. This study shows that extent of cast formation and IFTA in LCCN predicts the quality of renal response, which, in turn, is associated with overall survival.
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Affiliation(s)
- Virginie Royal
- Division of Pathology, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, QC, Canada
| | - Nelson Leung
- Division of Nephrology and Hypertension and Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | - Stéphan Troyanov
- Department of Medicine, Hôpital du Sacré-Cœur de Montréal, Université de Montréal, Montréal, QC, Canada
| | - Samih H Nasr
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Laure Écotière
- Department of Nephrology and Renal Transplantation, CIC INSERM 1402, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, CNRS UMR 7276, Limoges, and French Reference Centre for AL Amyloidosis, Poitiers, France
| | - Richard LeBlanc
- Division of Hemato-Oncology, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, QC, Canada
| | - Benjamin A Adam
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - Andrea Angioi
- Divisione di Nefrologia e Dialisi, Azienda Ospedaliera G. Brotzu, Cagliari, Italy
| | - Mariam P Alexander
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Anna Maria Asunis
- Department of Pathology, Azienda Ospedaliera G. Brotzu, Cagliari, Italy
| | - Antonella Barreca
- Division of Pathology, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Paola Bianco
- Department of Pathology, Azienda Ospedaliera G. Brotzu, Cagliari, Italy
| | - Camille Cohen
- Department of Nephrology, Hôpital Necker-Enfants Malades, AP-HP, Centre-Université de Paris, Paris, France
| | - Maria E Drosou
- Division of Nephrology and Hypertension and Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | - Huma Fatima
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL
| | - Roberta Fenoglio
- Nephrology and Dialysis Unit, S. Giovanni Bosco Hospital and University of Turin, Turin, Italy
| | - François Gougeon
- Division of Pathology, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Jean-Michel Goujon
- Department of Pathology and Ultrastructural Pathology, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Guillermo A Herrera
- Department of Pathology, College of Medicine, University of South Alabama, Mobile, AL
| | - Bertrand Knebelmann
- Department of Nephrology, Hôpital Necker-Enfants Malades, AP-HP, Centre-Université de Paris, Paris, France
| | - Nicola Lepori
- Divisione di Nefrologia e Dialisi, Azienda Ospedaliera G. Brotzu, Cagliari, Italy
| | - Francesca Maletta
- Division of Pathology, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Rita Manso
- Department of Pathology, Hospital Fernando Fonseca, Lisbon, Portugal
| | - Shveta S Motwani
- Dana-Farber Cancer Institute and Division of Nephrology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Antonello Pani
- Divisione di Nefrologia e Dialisi, Azienda Ospedaliera G. Brotzu, Cagliari, Italy
| | - Marion Rabant
- Department of Pathology, Hôpital Necker-Enfants Malades, AP-HP, Centre-Université de Paris, Paris, France
| | - Helmut G Rennke
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Dario Rocatello
- Nephrology and Dialysis Unit, S. Giovanni Bosco Hospital and University of Turin, Turin, Italy
| | - Frida Rosenblum
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL
| | - Paul W Sanders
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
- Department of Veterans Affairs Medical Center, Birmingham, AL
| | - Afonso Santos
- Department of Nephrology, Hospital Fernando Fonseca, Lisbon, Portugal; and
| | - Karina Soto
- Department of Nephrology, Hospital Fernando Fonseca, Lisbon, Portugal; and
| | - Banu Sis
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - Guy Touchard
- Department of Nephrology and Renal Transplantation, CIC INSERM 1402, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, CNRS UMR 7276, Limoges, and French Reference Centre for AL Amyloidosis, Poitiers, France
- Department of Pathology and Ultrastructural Pathology, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | | | - Frank Bridoux
- Department of Nephrology and Renal Transplantation, CIC INSERM 1402, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, CNRS UMR 7276, Limoges, and French Reference Centre for AL Amyloidosis, Poitiers, France
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5
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Waszczuk-Gajda A, Małyszko J, Vesole DH, Feliksbrot-Bratosiewicz M, Skwierawska K, Krzanowska K, Kobylińska K, Biecek P, Snarski E, Rodziewicz-Lurzyńska A, Kozłowski P, Stefaniak A, Drozd-Sokołowska J, Ziarkiewicz M, Vyas P, Boguradzki P, Mądry K, Biliński J, Tomaszewska A, Maciejewska M, Urbanowska E, Blajer B, Król M, Król M, Zborowska H, Jurczyszyn A, Dwilewicz-Trojaczek J, Jedrzejczak WW, Basak GW. Negative Impact of Borderline Creatinine Concentration and Glomerular Filtration Rate at Baseline on the Outcome of Patients With Multiple Myeloma Treated With Autologous Stem Cell Transplant. Transplant Proc 2020; 52:2186-2192. [PMID: 32222395 DOI: 10.1016/j.transproceed.2020.02.067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 02/13/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Renal impairment (RI) is one of the multiple myeloma (MM)-defining events for initiating therapy. After induction therapy, high-dose chemotherapy followed by autologous peripheral blood stem cell transplant (ASCT) remains the standard of care for transplant-eligible patients with MM. According to the International Myeloma Working Group (IMWG), the organ criterion for kidney damage is defined by a serum creatinine concentration (CrC) > 2 mg/dL or estimated glomerular filtration rate (eGFR) < 40 mL/min. In this long-term study, we evaluated the impact of CrC and eGFR calculated by the Modification of Diet in Renal Disease equation on progression-free and overall survival using a lower threshold than the IMWG criteria. PATIENTS AND METHODS We studied the longitudinal outcomes as measured by progression-free survival and overall survival in 59 transplant-eligible patients with MM: 38 patients with normal renal function and 21 patients with RI defined as a CrC higher than upper limit of normal (≥ 1.1 mg/dL), eGFR < 60 mL/min, treated with ASCT from 1998 to 2004. RESULTS The risk of disease progression and death following ASCT increased by 16.5% (P = .005) and 19% (P < .0009) per 1 mg/dL of CrC, respectively. The thresholds for the association of renal insufficiency and negative outcomes were CrC > 1.4 mg/dL and eGFR < 55mL/min. CONCLUSIONS We observed a negative correlation between minimal renal insufficiency and long-term outcomes. Management of patients with even marginally increased CrC and/or decreased eGFR not fulfilling IMWG RI criteria requires more concentrated effort to reverse even minimal renal insufficiency.
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Affiliation(s)
- Anna Waszczuk-Gajda
- Department of Hematology, Oncology and Internal Diseases, Warsaw Medical University, Warsaw, Poland.
| | - Jolanta Małyszko
- Department of Nephrology, Dialysistherapy and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - David H Vesole
- Myeloma Division, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey, United States
| | | | - Kamila Skwierawska
- Department of Hematology, Oncology and Internal Diseases, Warsaw Medical University, Warsaw, Poland
| | - Katarzyna Krzanowska
- Department of Nephrology, Jagiellonian University Medical College, Kraków, Poland
| | - Katarzyna Kobylińska
- University of Warsaw, Faculty of Mathematics, Informatics and Mechanics, Warsaw, Poland
| | - Przemysław Biecek
- University of Warsaw, Faculty of Mathematics, Informatics and Mechanics, Warsaw, Poland
| | - Emilian Snarski
- Department of Hematology, Oncology and Internal Diseases, Warsaw Medical University, Warsaw, Poland
| | | | - Paweł Kozłowski
- Central Laboratory, Clinical Center of Warsaw Medical University, Warsaw, Poland
| | - Agnieszka Stefaniak
- Cytogenetics Laboratory, Public Pediatric Teaching Hospital in Warsaw, Warsaw, Poland
| | - Joanna Drozd-Sokołowska
- Department of Hematology, Oncology and Internal Diseases, Warsaw Medical University, Warsaw, Poland
| | - Mateusz Ziarkiewicz
- Department of Hematology, Oncology and Internal Diseases, Warsaw Medical University, Warsaw, Poland
| | - Pyush Vyas
- Department of Hematology, Oncology and Internal Diseases, Warsaw Medical University, Warsaw, Poland
| | - Piotr Boguradzki
- Department of Hematology, Oncology and Internal Diseases, Warsaw Medical University, Warsaw, Poland
| | - Krzysztof Mądry
- Department of Hematology, Oncology and Internal Diseases, Warsaw Medical University, Warsaw, Poland
| | - Jarosław Biliński
- Department of Hematology, Oncology and Internal Diseases, Warsaw Medical University, Warsaw, Poland
| | - Agnieszka Tomaszewska
- Department of Hematology, Oncology and Internal Diseases, Warsaw Medical University, Warsaw, Poland
| | - Martyna Maciejewska
- Department of Hematology, Oncology and Internal Diseases, Warsaw Medical University, Warsaw, Poland
| | - Elżbieta Urbanowska
- Department of Hematology, Oncology and Internal Diseases, Warsaw Medical University, Warsaw, Poland
| | - Beata Blajer
- Department of Hematology, Oncology and Internal Diseases, Warsaw Medical University, Warsaw, Poland
| | - Małgorzata Król
- Department of Hematology, Oncology and Internal Diseases, Warsaw Medical University, Warsaw, Poland
| | - Maria Król
- Department of Hematology, Oncology and Internal Diseases, Warsaw Medical University, Warsaw, Poland
| | - Hanna Zborowska
- Department of Hematology, Jagiellonian University, Kraków, Poland
| | - Artur Jurczyszyn
- Department of Hematology, Jagiellonian University, Kraków, Poland
| | | | - Wieslaw W Jedrzejczak
- Department of Hematology, Oncology and Internal Diseases, Warsaw Medical University, Warsaw, Poland
| | - Grzegorz W Basak
- Department of Hematology, Oncology and Internal Diseases, Warsaw Medical University, Warsaw, Poland
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6
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Dimopoulos M, Siegel D, White DJ, Boccia R, Iskander KS, Yang Z, Kimball AS, Mezzi K, Ludwig H, Niesvizky R. Carfilzomib vs bortezomib in patients with multiple myeloma and renal failure: a subgroup analysis of ENDEAVOR. Blood 2019; 133:147-55. [PMID: 30478094 DOI: 10.1182/blood-2018-06-860015] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 10/27/2018] [Indexed: 12/20/2022] Open
Abstract
In ENDEAVOR, carfilzomib (56 mg/m2) and dexamethasone (Kd56) demonstrated longer progression-free survival (PFS) over bortezomib and dexamethasone (Vd) in patients with relapsed/refractory multiple myeloma (RRMM). Here we evaluated Kd56 vs Vd by baseline renal function in a post hoc exploratory subgroup analysis. The intent-to-treat population included 929 patients (creatinine clearance [CrCL] ≥15 to <50 mL/min, n = 85 and n = 99; CrCL 50 to <80 mL/min, n = 186 and n = 177; and CrCL ≥80 mL/min, n = 193 and n = 189 for Kd56 and Vd arms, respectively). In these respective subgroups, median PFS was 14.9 vs 6.5 months (hazard ratio [HR], 0.49; 95% confidence interval [CI], 0.320-0.757), 18.6 vs 9.4 months (HR, 0.48; 95% CI, 0.351-0.652), and not reached (NR) vs 12.2 months (HR, 0.60; 95% CI, 0.434-0.827) for those receiving Kd56 vs Vd, respectively; median overall survival (OS) was 42.1 vs 23.7 months (HR, 0.66; 95% CI, 0.443-0.989), 42.5 vs 32.8 months (HR, 0.83; 95% CI, 0.626-1.104), and NR vs 42.3 months (HR, 0.75; 95% CI, 0.554-1.009). Complete renal response (ie, CrCL improvement to ≥60 mL/min in any 2 consecutive visits if baseline CrCL <50 mL/min) rates were 15.3% (95% CI, 8.4-24.7) and 14.1% (95% CI, 8.0-22.6) for those receiving Kd56 vs Vd, respectively. In a combined Kd56 and Vd analysis, complete renal responders had longer median PFS (14.1 vs 9.4 months; HR, 0.805; 95% CI, 0.438-1.481) and OS (35.3 vs 29.7 months; HR, 0.91; 95% CI, 0.524-1.577) vs nonresponders. Grade ≥3 adverse event rates in the respective subgroups were 87.1% vs 79.4%, 84.4% vs 71.8%, and 77.1% vs 65.9% for those receiving Kd56 vs Vd, respectively. Thus, Kd56 demonstrated PFS and OS improvements over Vd in RRMM patients regardless of their baseline renal function. The ENDEAVOR trial was registered at www.clinicaltrials.gov as #NCT01568866.
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7
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Oortgiesen BE, Azad R, Hemmelder MH, Kibbelaar RE, Veeger NJGM, de Vries JC, van Roon EN, Hoogendoorn M. The impact of the introduction of bortezomib on dialysis independence in multiple myeloma patients with renal impairment: a nationwide Dutch population-based study. Haematologica 2018; 103:e311-e314. [PMID: 29545339 DOI: 10.3324/haematol.2017.184754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Berdien E Oortgiesen
- Department of Clinical Pharmacy and Pharmacology, Medical Center Leeuwarden, the Netherlands
| | - Roshna Azad
- Department of Clinical Pharmacy and Pharmacology, Medical Center Leeuwarden, the Netherlands
| | - Marc H Hemmelder
- Department of Nephrology, Medical Center Leeuwarden, the Netherlands
| | - Robby E Kibbelaar
- Department of Pathology, Pathology Friesland, Leeuwarden, the Netherlands
| | - Nic J G M Veeger
- Department of Epidemiology, MCL Academy, Leeuwarden, the Netherlands.,Department of Epidemiology, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Joost C de Vries
- Department of Hematology, Medical Center Leeuwarden, the Netherlands
| | - Eric N van Roon
- Unit of Pharmacotherapy, Epidemiology and Economics, Department of Pharmacy, University of Groningen, the Netherlands
| | - Mels Hoogendoorn
- Department of Hematology, Medical Center Leeuwarden, the Netherlands
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8
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Kibbelaar RE, Oortgiesen BE, van der Wal-Oost AM, Boslooper K, Coebergh JW, Veeger NJGM, Joosten P, Storm H, van Roon EN, Hoogendoorn M. Bridging the gap between the randomised clinical trial world and the real world by combination of population-based registry and electronic health record data: A case study in haemato-oncology. Eur J Cancer 2017; 86:178-85. [PMID: 28992561 DOI: 10.1016/j.ejca.2017.09.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 09/01/2017] [Accepted: 09/04/2017] [Indexed: 11/21/2022]
Abstract
Randomised clinical trials (RCTs) are considered the basis of evidence-based medicine. It is recognised more and more that application of RCT results in daily practice of clinical decision-making is limited because the RCT world does not correspond with the clinical real world. Recent strategies aiming at substitution of RCT databases by improved population-based registries (PBRs) or by improved electronic health record (EHR) systems to provide significant data for clinical science are discussed. A novel approach exemplified by the HemoBase haemato-oncology project is presented. In this approach, a PBR is combined with an advanced EHR, providing high-quality data for observational studies and support of best practice development. This PBR + EHR approach opens a perspective on randomised registry trials.
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Oortgiesen BE, van Roon E, Joosten P, Kibbelaar RE, Storm H, Hovenga S, van Rees B, Woolthuis G, Veeger N, de Waal E, Hoogendoorn M. The role of initial clinical presentation, comorbidity and treatment in multiple myeloma patients on survival: a detailed population-based cohort study. Eur J Clin Pharmacol 2017; 73:771-8. [DOI: 10.1007/s00228-017-2227-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 02/22/2017] [Indexed: 12/22/2022]
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