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Kidney Week

Abstract: SA-PO187

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

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

  • Portela Neto, Antonio Abel, University State of 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
  • Costalonga, Elerson, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
  • Torres, Veronica, Sao Paulo State Cancer Institute - USP, Sao Paulo, Brazil
Background

The renal impairment (RI) at multiple myeloma (MM) ranged from 20 to 50% and RI is associated with reduced survival. The new criteria from the International Myeloma Working Group (IMWG) defined RI as serum creatinine (SCr) > 2.0 mg/dL or eGFR < 40 ml/min/1.73 m2. If these definitions are associated to overall survival (OS) is still debatable.

Methods

All patients with newly diagnosed MM (up to three months) admitted for treatment at the Sao Paulo State Cancer Institute, between February 2012 and May 2016, were followed for a minimum of three years. Exclusion criteria were: age < 18 years; pts on dialysis; initiation of MM treatment before recruitment or exams; pts with follow up < 3 months. Chronic Kidney Disease (CKD) was diagnosed as eGFR < 60 ml/min/1.73 m2. GFR was estimated by the CKD EPI formula. International Staging System (ISS) relyed on serum albumin (Alb) and ß2 microglobulin (B2M).

Results

255 pts were enrolled. Pts median age 61.70 ± 13.2 years (40.4% older than 65 yrs), 50.9% had hypertension and 20.4% diabetes. ECOG index was 0-2 in 61% of pts. Heavy chain IgG in 55.9% of pts and kappa light chain was in 65.8%. The Durie-Salmon stage III (DS-III) in 86.4% and ISS-III in 32.2% of pts. Exams associated with MM activity/prognosis were: 49% hemoglobin (Hb) < 10 g/dL; 13.3% total calcium (CaT) > 11 mg/dL; 45.9% Alb < 3.5 g/dL; 54.5% B2M > 3.5 mg/L; 30.6% elevated LDH. SCr was 1.06 (0.81 – 1.45) mg/dL and eGFR was 70.2 (44.5 – 91.7) ml/min/1.73 m2. 14% of pts had RI with SCr > 2.0 mg/dL; CKD 3 was detected in 40.4% pts. Overall survival (OS) was 3.50 (1.74 – 4.95) years. No pts characteristics (age, performance, heavy of light chain type), CaT, Hb, Alb or DS-III were related to reduced OS. Neither was SCr > 2.0 mg/dL (P=0.730), eGFR < 40 ml/min/1.73 m2(P=0.414). Variables related to low OS were CKD 3 (P=0.011), ISS-III (P=0.011) and B2M > 3.5 mg/L (P<0.0001). Elevated LDH value was marginally related to reduced OS (P=0.090). On Cox regression model, B2M > 3.5 mg/L (HR: 1.63 [1.02 – 2.63]) and abnormal LDH (HR: 1.61 [1.01 – 2.56]) were associated with lower OS.

Conclusion

KDIGO CKD definition seems to be superior to the IMWG criteria to assess the impact of RI on the prognosis of newly diagnosed MM pts. Markers of higher burden disease are strongly related to reduced survival.

Funding

  • Private Foundation Support