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Kidney Week

Abstract: FR-PO836

Outcomes of Treatment of Myeloma in Patients Requiring Renal Replacement Therapy – A Single Centre Experience

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Ratnayake, Aruni, Epsom and St Helier University Hospitals NHS Trust, London, United Kingdom
  • Srikantharajah, Mukunthan, Epsom and St Helier University Hospitals NHS Trust, London, United Kingdom
  • Makanjuola, David, Epsom and St Helier University Hospitals NHS Trust, London, United Kingdom
  • Stern, Simon C., Epsom and St Helier University Hospitals NHS Trust, London, United Kingdom
Background

Renal impairment is a complication of multiple myeloma (MM). The incidence of renal impairment at diagnosis of MM is 20-50%; about 10% of these present with acute kidney injury requiring renal replacement therapy (RRT). Treatments including Bortezomib have improved prognosis with full or partial recovery of renal function; however they cause side effects e.g. peripheral neuropathy. We reviewed outcomes of MM treatments in patients requiring RRT over an 11 year period.

Methods

Patients diagnosed with MM requiring RRT between January 2007 - December 2017 were identified. Patient data was obtained from electronic records.

Results

29 patients met the inclusion criteria. Median age 64 years (range 45-86); 59% were male; 72% were Caucasian. Median follow up time was 33 months (range 8-96 months).

65% (N=19) were treated with first line chemotherapy including Bortezomib; of these 84% showed complete (21%), or partial (63%) response to therapy. 1 year survival was 89% (N=19), 5 year survival 71% (N=14). Complications were thrombosis (11%), neuropathy (53%) and infection requiring hospital admission (42%). 37% recovered enough renal function to cease RRT.

35% (N=10) did not have Bortezomib as part of initial treatment. Of these 50% responded to therapy; all with partial response, none with complete response. 1 year survival was 90% (N=10), 5 year survival was 50% (N=10). Complications were thrombosis (20%) and infection requiring hospital admission (20%). No patient experienced neuropathy. Only 10% recovered sufficient renal function to stop RRT.

Patients who gained dialysis independence had significant reduction of free light chains after 2 chemotherapy cycles (median 85%, range 61%-99%). Those who were still on RRT had more variation in change in free light chains ranging from -99% to +63%.

Conclusion

Our study coincides with the introduction of Bortezomib as first-line treatment in 2010. In our cohort, Bortezomib resulted in increased rates of response to first line therapy, greater likelihood of dialysis independence and improved overall survival. However, more side effects were associated with Bortezomib. As has been shown in patients with renal amyloid (Rezk et al, Kidney International 2017), reduction of free light chains post chemotherapy can be used as a predictor for dialysis independence and our results support this.