title: The implication of compromised renal function at presentation in myeloma: similar outcome in patients who receive high-dose therapy: a single-center study of 251 previously untreated patients.
abstract: The purpose of the study was to determine the role of sequential therapy (ST) in new patients with myeloma presenting with renal dysfunction (RD): serum creatinine >140 micromol/L (1.6 mg/dL). Between April 1985 and June 1998, 251 patients, 59 (23%) with RD were entered into a ST program comprised of infusional chemotherapy (IC) with VAMP/C-VAMP (vincristine, doxorubicin, and methylprednisolone with/without cyclophosphamide) followed by autologous transplantation and interferon maintenance. The median overall survival (OS) of 251 patients from the start of IC was 4.2 yr with the RD group faring significantly poorer (median 2.5 yr) than those with no renal dysfunction (NRD; median 4.6 yr; p = 0.0025). Mortality during the first 100 d of IC was significantly higher in patients with RD (11/59; p = 0.01) compared to patients with NRD. In patients consolidated with high-dose therapy, the OS and event-free survival (EFS) were not significantly different between the two groups. Cox analysis of the variables at presentation failed to show RD as a factor influencing outcome, but it showed that patients with beta-2-microglobulin (beta2M) > or = 3.7 (p < 0.0001), age > or = 52.5 yr (p = 0.002), performance status (PS) > or = 2 (p = 0.005) and patients with light-chain myeloma (p = 0.03) had a significantly shorter OS, beta2M > or = 3.7, PS > or = 2, and light-chain myeloma were predictive of shorter EFS. The study shows that with modern intensive schedules of treatment, renal disease at presentation in isolation does not compromise outcome.
authors.affiliation: Leukaemia and Myeloma Units, Royal Marsden NHS Trust, Sutton, Surrey, United Kingdom.
authors.forename: B
authors.initials: B
authors.lastname: Sirohi
authors.forename: R
authors.initials: R
authors.lastname: Powles
authors.forename: J
authors.initials: J
authors.lastname: Mehta
authors.forename: J
authors.initials: J
authors.lastname: Treleaven
authors.forename: N
authors.initials: N
authors.lastname: Raje
authors.forename: S
authors.initials: S
authors.lastname: Kulkarni
authors.forename: C
authors.initials: C
authors.lastname: Rudin
authors.forename: N
authors.initials: N
authors.lastname: Bhagwati
authors.forename: C
authors.initials: C
authors.lastname: Horton
authors.forename: R
authors.initials: R
authors.lastname: Saso
authors.forename: S
authors.initials: S
authors.lastname: Singhal
authors.forename: R
authors.initials: R
authors.lastname: Parikh
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D016026:Bone Marrow Transplantation; D003131:Combined Modality Therapy; D003404:Creatinine / Q000097:blood; D003520:Cyclophosphamide / Q000008:administration & dosage; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007372:Interferons / Q000627:therapeutic use; D007674:Kidney Diseases / Q000209:etiology*; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications* / Q000188:drug therapy*; D012189:Retrospective Studies; D016019:Survival Analysis; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D000970:Antineoplastic Agents; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D007372:Interferons; D003404:Creatinine; D008775:Methylprednisolone