title: Autologous hematopoietic stem cell transplantation may reverse renal failure in patients with multiple myeloma.
abstract: Approximately 20% of patients with multiple myeloma (MM) have renal failure at diagnosis, and about 5% are dialysis-dependent. Many of these patients are considered ineligible for autologous hematopoietic stem cell transplantation (auto-HSCT) because of a high risk of treatment-related toxicity. We evaluated the outcome of 46 patient with MM and renal failure, defined as serum creatinine >2 mg/dL sustained for >1 month before the start of preparative regimen. Patients received auto-HSCT at our institution between September 1997 and September 2006. Median serum creatinine and creatinine clearance (CrCl) at auto-HSCT were 2.9 mg/dL (range: 2.0-12.5) and 33 mL/min (range: 8.7-63), respectively. Ten patients (21%) were dialysis-dependent. Median follow-up in surviving patients was 34 months (range: 5-81). Complete (CR) and partial responses (PR) after auto-HSCT were seen in 9 (22%) and 22 (53%) of the 41 evaluable patients, with an overall response rate of 75%. Two patients (4%) died within 100 days of auto-HSCT. Grade 2-4 nonhematologic adverse events were seen in 18 patients (39%) and included cardiac arrythmias, pulmonary edema, and hyperbilirubinemia. Significant improvement in renal function, defined as an increase in flomerular filtration rate (GFR) by 25% above baseline, was seen in 15 patients (32%). Kaplan-Meier estimates of 3-year progression-free survival (PFS) and overall survival (OS) were 36% and 64%, respectively. In conclusion, auto HSCT can be offered to patients with MM and renal failure with acceptable toxicity and with a significant improvement in renal function in approximately one-third of the transplanted patients. In this analysis, a melphalan (Mel) dose of 200 mg/m(2) was not associated with an increase in toxicity or nonrelapse (Mel) mortality (NRM).
authors.affiliation: Department of Stem Cell Transplantation and Cellular Therapy, M.D. Anderson Cancer Center, Houston, TX 77030, USA.
authors.forename: Gaurav C
authors.initials: GC
authors.lastname: Parikh
authors.forename: Ali Imran
authors.initials: AI
authors.lastname: Amjad
authors.forename: Rima M
authors.initials: RM
authors.lastname: Saliba
authors.forename: Syed M A
authors.initials: SM
authors.lastname: Kazmi
authors.forename: Ziad U
authors.initials: ZU
authors.lastname: Khan
authors.forename: Amit
authors.initials: A
authors.lastname: Lahoti
authors.forename: Chitra
authors.initials: C
authors.lastname: Hosing
authors.forename: Floralyn
authors.initials: F
authors.lastname: Mendoza
authors.forename: Suhail R
authors.initials: SR
authors.lastname: Qureshi
authors.forename: Donna M
authors.initials: DM
authors.lastname: Weber
authors.forename: Michael
authors.initials: M
authors.lastname: Wang
authors.forename: Uday
authors.initials: U
authors.lastname: Popat
authors.forename: Amin M
authors.initials: AM
authors.lastname: Alousi
authors.forename: Richard E
authors.initials: RE
authors.lastname: Champlin
authors.forename: Sergio A
authors.initials: SA
authors.lastname: Giralt
authors.forename: Muzaffar H
authors.initials: MH
authors.lastname: Qazilbash
mesh_terms: D000328:Adult; D000368:Aged; D000818:Animals; D003404:Creatinine / Q000097:blood; D018572:Disease-Free Survival; D005919:Glomerular Filtration Rate; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000097:blood / Q000150:complications / Q000401:mortality / Q000628:therapy*; D020127:Recovery of Function; D051437:Renal Insufficiency / Q000097:blood / Q000150:complications / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D015996:Survival Rate; D014182:Transplantation, Autologous
chemical_list: D003404:Creatinine