title: Renal impairment is not an independent adverse prognostic factor in patients with multiple myeloma treated upfront with novel agent-based regimens.
abstract: Abstract   Renal impairment (RI) is a common presenting complication of multiple myeloma associated with significant morbidity and early mortality, while it has been associated with inferior survival in patients treated with conventional regimens. We assessed the impact of RI in 203 unselected consecutive patients treated upfront with novel agents (thalidomide, lenalidomide, bortezomib). RI was assessed by the estimated glomerular filtration rate (eGFR). RI (eGFR <60 mL/min) was present in 93 (45.8%) of patients at diagnosis and was associated with advanced age, advanced International Staging System (ISS) stage, poorer performance status, hypercalcemia, urine Bence-Jones proteinuria, anemia and thrombocytopenia. Myeloma response rates were similar for patients with or without RI. In univariate analysis RI was associated with shorter survival and a higher rate of early death (7% vs. 3.5%); however, when adjusted for other prognostic factors, RI was not independently associated with survival. In conclusion, in unselected newly diagnosed patients treated with novel agent-based therapies, RI is not independently associated with inferior survival, probably due to the significant activity of novel agents even in the context of RI.
authors.affiliation: Department of Clinical Therapeutics, University of Athens, School of Medicine, Alexandra Hospital, Athens, Greece.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Eleftherakis-Papapiakovou
authors.forename: Esftathios
authors.initials: E
authors.lastname: Kastritis
authors.forename: Maria
authors.initials: M
authors.lastname: Roussou
authors.forename: Maria
authors.initials: M
authors.lastname: Gkotzamanidou
authors.forename: Irini
authors.initials: I
authors.lastname: Grapsa
authors.forename: Erasmia
authors.initials: E
authors.lastname: Psimenou
authors.forename: Nikitas
authors.initials: N
authors.lastname: Nikitas
authors.forename: Evangelos
authors.initials: E
authors.lastname: Terpos
authors.forename: Meletios A
authors.initials: MA
authors.lastname: Dimopoulos
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001897:Boronic Acids / Q000008:administration & dosage; D000069286:Bortezomib; D005260:Female; D006801:Humans; D000077269:Lenalidomide; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications* / Q000188:drug therapy* / Q000401:mortality; D011379:Prognosis; D011719:Pyrazines / Q000008:administration & dosage; D051437:Renal Insufficiency / Q000150:complications* / Q000401:mortality; D016019:Survival Analysis; D013792:Thalidomide / Q000008:administration & dosage / Q000031:analogs & derivatives; D016896:Treatment Outcome
chemical_list: D001897:Boronic Acids; D011719:Pyrazines; D013792:Thalidomide; D000069286:Bortezomib; D000077269:Lenalidomide