Abstract: SA-PO188
Impact of Autologous Stem Cell Transplant in Myeloma Patients on Renal Function, Progression-Free Survival, and Overall Survival: A Longitudinal Analysis
Session Information
- Onco-Nephrology: Clinical
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Onco-Nephrology
- 1500 Onco-Nephrology
Authors
- Abudayyeh, Ala, University of Texas MD Anderson Cancer Center, Houston, Texas, United States
- Mamlouk, Omar, University of Texas Health Science Center, Houston, Texas, United States
- Abdelrahim, Maen, Houston Methodist Cancer Center, Houston, Texas, United States
- Lin, Yan Heather, University of Texas MD Anderson Cancer Center, Houston, Texas, United States
- Rajasekaran, Arun, University of Alabama, Birmingham, Alabama, United States
- Sanders, Paul W., University of Alabama, Birmingham, Alabama, United States
- Qazilbash, Muzaffar, University of Texas MD Anderson Cancer Center, Houston, Texas, United States
Background
Renal impairment has been negatively associated with progression free survival (PFS) and overall survival in patients diagnosed with multiple myeloma (MM). Autologous stem cell transplant (ASCT) has become a standard of care for treatment in MM. Most previous studies have assessed the safety of ASCT and the improvement in renal function in patients with MM. In our study we sought to understand how renal function was impacted over time, the predictors of renal function, progression free survival and overall survival after ASCT.
Methods
We performed a retrospective review of all MM patients who underwent ASCT at MDACC from January1, 2008 through December 31, 2013. A total of 885 none dialysis patients who received Melphalan alone as the conditioning regimen were identified. We collected demographic information, ISS stage, disease status at time of transplant (Day 0), and at last follow up. Creatinine, GFR (calculated using CKD Epi equation), calcium, and LDH were also collected at day 0, 100, 180, & 365. Given the longitudinal nature of the data, linear mixed effect models were used to study the change of GFR over time. A joint model approach for longitudinal, PFS and survival data was used to assess association of GFR with above variables. As sensitivity analyses, landmark analyses were conducted with day 0, 100, 180, and 365 days post-transplant as landmark time points.
Results
Patients’ GFR at post-transplant time points were significantly higher (p ≤ 0.025) compared to the day of ASCT. A higher ISS stage at diagnosis was significantly associated with a lower GFR (p < .0001) at all stages of chronic kidney disease. GFR value was not significantly associated with OS in any of the analyses described above. eGFR was not significantly associated with PFS when it was included in the models as a binary variable using median as the cutoff. However, disease status, ISS stage, response to induction prior to SCT were all associated with shorter OS.
Conclusion
The study demonstrates in a large cohort and in a longitudinal manner that MM patients who underwent ASCT did not have further decline in GFR over time. In addition, GFR was strongly associated with ISS stage. As far as OS, PFS, MM-related factors significantly impacted the survival while GFR did not.
Funding
- Other NIH Support