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Abstract: SA-PO148

Impact of Renal Impairment Criteria on Survival of Patients With Newly Diagnosed Multiple Myeloma

Session Information

Category: Onconephrology

  • 1600 Onconephrology

Authors

  • Strufaldi, Fernando Louzada, Universidade de Sao Paulo Hospital das Clinicas, Sao Paulo, São Paulo, Brazil
  • Segura, Gabriela C., Universidade de Sao Paulo Hospital das Clinicas, Sao Paulo, São Paulo, Brazil
  • Caires, Renato Antunes, Universidade de Sao Paulo Instituto do Cancer do Estado de Sao Paulo, Sao Paulo, São Paulo, Brazil
  • Mattedi, Francisco Zanotelli, Universidade de Sao Paulo Instituto do Cancer do Estado de Sao Paulo, Sao Paulo, São Paulo, Brazil
  • Costalonga, Elerson, Universidade de Sao Paulo Instituto do Cancer do Estado de Sao Paulo, Sao Paulo, São Paulo, Brazil
  • Martinez, Gracia, Universidade de Sao Paulo Instituto do Cancer do Estado de Sao Paulo, Sao Paulo, São Paulo, Brazil
  • Costa e Silva, Veronica Torres, Universidade de Sao Paulo Instituto do Cancer do Estado de Sao Paulo, Sao Paulo, São Paulo, Brazil
Background

The International Myeloma Working Group(IMWG) defines renal impairment(RI) as serum creatinine (SCr)>2.0 mg/dL or estimated glomerular filtration rate(eGFR)<40 ml/min/1.73m2 at the diagnosis of multiple myeloma(MM)(RI-IMWG). Our aim is to assess if different criteria used to evaluate RI have an impact on the overall survival(OS) in newly diagnosed MM patients(pts)

Methods

We screened all pts with newly diagnosed MM admitted for treatment at the Sao Paulo State Cancer Institute, between January 2009 and September 2018. Exclusion criteria were: age<18 y, maintenance dialysis, treatment ineligibility, and follow-up< 3 months. eGFR was determined by the 2009 CKD-EPI equation and expressed as ml/min/1.73m2. Chronic Kidney Disease(CKD) criteria was eGFR<60. Acute Kidney Injury(AKI) was classified according to the KDIGO criteria. Baseline SCr was defined as the lowest SCr within 3 months before admission or, if absent, as the lowest SCr during follow-up. Clinical stage was assessed by International Staging System(ISS)(based on serum albumin [Alb] and beta 2 microglobulin [B2M])

Results

We enrolled 557 pts. Median age(IQR) was 62.0(54.2-69.9)y, 56.5% were male. ISS stage III(ISS-III) was observed in 36.1%. Alb<3.5g/dL(Albu), B2M>3.5mg/L(B2Ma), and lactate dehydrogenase above normal limit(LDHa) were observed in 42.4,55.6, and 20.6%, respectively. eGFR at baseline and at diagnosis were 78.7(53.4-97.4), and 68.9(40.8-92.9), respectively. At diagnosis, CKD, RI-IMWG, AKI, and AKI-3 were observed in 28.6, 23.3, 25.5, and 10.6% of patients, respectively. OS was 3.0(1.0 – 4.25)y. In the univariate analysis(long-rank test), variables related to reduced OS(p<0.05) were: age, diabetes, LDHa, ISS-III, B2Ma, CKD, AKI-3, RI-IMWG. Albu and AKI-1 were not associated with reduced OS. Variables retained on Cox Regression Model(CRM) are described in table. RI-IMWG and CKD were not retained in additional CRM(data not shown)

Conclusion

Although highly accepted, RI-IMWG definition neither distinguishes CKD from AKI nor performs as well as AKI-3 as an independent predictor of mortality in newly diagnosed MM