title: Dialysis-dependent renal failure in patients with myeloma can be reversed by high-dose myeloablative therapy and autotransplant.
abstract: To evaluate the role of high-dose melphalan and autologous transplant (AT) in reversing dialysis-dependent renal failure, 59 patients still on dialysis at the time of AT were analyzed. A total of 37 patients had been on dialysis < or =6 months. A 5-year event-free and overall survival rate of all patients after AT was 24 and 36%, respectively. Of 54 patients evaluable for renal function improvement, 13 (24%) became dialysis independent at a median of 4 months after AT (range: 1-16). Dialysis duration < or =6 months prior to first AT and pre-transplant creatinine clearance >10 ml/min were significant for renal function recovery: 12 of 36 (33%) < or =6 months vs one of 18 patients (6%) >6 months on dialysis recovered renal function; 10 of 26 (38%) with >10 ml/min vs three of 28 (11%) with < or =10 ml/min of creatinine clearance (both P<0.05). Quality of response after autotransplant was also significant: 12 of 31 (39%) being greater than partial remission after AT vs one of 21 patients (5%) attaining partial remission or less became independent of dialysis (P<0.05). Our data suggest that significant renal failure can be reversible and AT should be considered early in the disease course.
authors.affiliation: The Myeloma Institute for Research and Therapy, The University of Arkansas for Medical Sciences, Little Rock, 72205, USA. leechoonkee@uams.edu
authors.forename: C-K
authors.initials: CK
authors.lastname: Lee
authors.forename: M
authors.initials: M
authors.lastname: Zangari
authors.forename: B
authors.initials: B
authors.lastname: Barlogie
authors.forename: A
authors.initials: A
authors.lastname: Fassas
authors.forename: F
authors.initials: F
authors.lastname: van Rhee
authors.forename: R
authors.initials: R
authors.lastname: Thertulien
authors.forename: G
authors.initials: G
authors.lastname: Talamo
authors.forename: F
authors.initials: F
authors.lastname: Muwalla
authors.forename: E
authors.initials: E
authors.lastname: Anaissie
authors.forename: K
authors.initials: K
authors.lastname: Hollmig
authors.forename: G
authors.initials: G
authors.lastname: Tricot
mesh_terms: D000328:Adult; D000368:Aged; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008558:Melphalan / Q000008:administration & dosage; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications* / Q000628:therapy*; D011379:Prognosis; D006435:Renal Dialysis; D014182:Transplantation, Autologous
chemical_list: D018906:Antineoplastic Agents, Alkylating; D008558:Melphalan