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Kidney Week

Abstract: SA-PO420

Assessment of Renal Impairment on the Prognosis of Newly Diagnosed Multiple Myeloma

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 302 CKD: Estimating Equations, Incidence, Prevalence, Special Populations

Authors

  • Costa e Silva, Veronica T., University of Sao Paulo School of Medicine, Sao Paulo, Brazil
  • Costalonga, Elerson, School of Medicine, University of Sao Paulo, São Paulo, SÃO PAULO, Brazil
  • Frediani, Marcella Martins, HC-FMUSP, Sao Paulo, Brazil
  • Caires, Renato Antunes, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
  • Coelho, Fernanda O., None, São Paulo, São PAULO, Brazil
  • Burdmann, Emmanuel A., University of Sao Paulo Medical School, Sao Paulo, Brazil
  • Portela Neto, Antonio Abel, University State of São Paulo, São Paulo, Brazil
  • Silva, Adriel Gracco, USP, São Paulo, Brazil
Background

Severe Renal Impairment (RI) is associated with early death in patients (pts) with multiple myeloma (MM). The new criteria from the International Myeloma Working Group (IMWG) defined RI as serum creatinine (SCr) > 2.0 mg/dL or estimated glomerular filtration rate (eGFR) < 40 ml/min/1.73 m2. If these definitions are associated to overall survival (OS) is still debatable.

Methods

All pts with newly diagnosed MM (up to three months) admitted for treatment at the Hematology Outpatient Service from the Sao Paulo State Cancer Institute, between February 2012 and January 2014, were prospectively followed. Exclusion criteria were: age < 18 years; pts on maintenance dialysis; follow up < 3 months. Chronic Kidney Disease (CKD) was diagnosed as eGFR < 60 ml/min/1.73 m2. GFR was estimated by the CKD Epidemiology Collaboration formula. International Staging System (ISS) relyed on serum albumin (Alb) and ß2 microglobulin (B2M).

Results

One hundred twenty pts were enrolled. Pts characteristics were age 62.02 ± 11.2 years, 56.2% male. MM type was IgG Kappa in 59% of cases and 21% of pts had light chain MM. The clinical stages included Durie-Salmon stage III (DS-III) in 81% and ISS stage III (ISS-III) in 30% of pts. Serum exams were: 43% hemoglobin (Hb) < 10 g/dL; 14.3% total calcium (CaT) > 11 mg/dL; 39.2% SAlb < 3.5 g/dL; 54.5% B2M > 3.5 mg/L; 18.3% lactate dehydrogenase (LDH) > normal value. At the moment of enrollment, SCr was 1.05 (0.74 – 1.43) mg/dL and eGFR was 69.8 (42.7 – 97.1) ml/min/1.73 m2. Thirteen percent of pts had RI with SCr > 2.0 mg/dL; CKD stage 3 was detected in 43% pts. Overall survival (OS) was 3.70 (1.97 – 4.44) years. No pts characteristics, CaT, Hb or DS-III were related to reduced OS. Neither was SCr > 2.0 mg/dL (P=0.425) or eGFR < 40 ml/min/1.73 m2(P=0.189). Conversely, CKD stage 3 was associated to reduced OS (3.26 [1.56 – 4.41] vs 3.72 (2.69 – 4.96) years, P=0.032) as well as ISS-III (P=0.022). On Cox regression model, only B2M > 3.5 mg/L (Hazard Ratio : 2.14 [1.03 – 4.42]) and LDH > normal value (Hazard Ratio: 2.74 [1.45 – 5.18]) were associated with lower OS.

Conclusion

Currently used KDIGO CKD definitions seem to be superior than the new IMWG criteria to assess the impact of RI on the prognosis of newly diagnosed MM pts.