Dialysis-dependent renal failure in patients with myeloma can be reversed by high-dose myeloablative therapy and autotransplant.
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.
Lee
C-K
CK
The Myeloma Institute for Research and Therapy, The University of Arkansas for Medical Sciences, Little Rock, 72205, USA. leechoonkee@uams.edu
Zangari
M
M
Barlogie
B
B
Fassas
A
A
van Rhee
F
F
Thertulien
R
R
Talamo
G
G
Muwalla
F
F
Anaissie
E
E
Hollmig
K
K
Tricot
G
G
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
D018906:Antineoplastic Agents, Alkylating; D008558:Melphalan