title: Successful treatment of patients with multiple myeloma and impaired renal function with lenalidomide: results of 4 German centers.
abstract: Retrospective multicenter analysis of 26 patients with multiple myeloma to assess the efficacy and toxicity of relapse treatment with lenalidomide/dexamethasone in renal-function impairment. Analysis showed myeloma overall response rate of 84%, with 42% of patients with improvement of renal function. Lenalidomide/dexamethasone is highly effective, with acceptable toxicity in the renally impaired patient group.
  
  
  OBJECTIVE
  Renal impairment is one of the main complications of multiple myeloma associated with unfavorable prognosis. Lenalidomide in combination with dexamethasone is an effective treatment of relapsed and/or refractory multiple myeloma and may be used in patients with myeloma and with renal insufficiency with appropriate dose adaption according to creatinine clearance (CLCr). However, there are limited data on the use of this regimen in patients with myeloma and with impaired renal function.
  
  
  METHODS
  We report on 26 patients, in 4 German centers, with impaired renal function and relapsed and/or refractory multiple myeloma who were treated with lenalidomide/dexamethasone-based regimens; we retrospectively analyzed their data.
  
  
  RESULTS
  All 26 patients had a CLCr < 60 mL/min. Six patients were permanently or temporarily dialysis dependent. Overall response rate (ie, at least a partial response) was 84%. The rate of renal response (at least minor renal response) was 42%, with 6 patients achieving a complete renal response. A median time of 28 days was documented until first response. Six patients had grade 3/4 thromboembolic events; all but one of these patients received prophylaxis with acetylsalicylic acid.
  
  
  CONCLUSIONS
  Lenalidomide-based treatment is highly effective and is an attractive treatment option in patients with multiple myeloma with impaired renal function. In this analysis, renal function was improved in a substantial proportion of patients.
authors.affiliation: Division of Hematology, Oncology and Immunology, Medical Department, University Hospital of Tübingen, Tübingen, Germany. Katharina.Oehrlein@med.uni-tuebingen.de
authors.forename: Katharina
authors.initials: K
authors.lastname: Oehrlein
authors.forename: Christian
authors.initials: C
authors.lastname: Langer
authors.forename: Isrid
authors.initials: I
authors.lastname: Sturm
authors.forename: Wolfram
authors.initials: W
authors.lastname: Pönisch
authors.forename: Corinna
authors.initials: C
authors.lastname: Hahn-Ast
authors.forename: Sigrid
authors.initials: S
authors.lastname: Kuhn
authors.forename: Katja C
authors.initials: KC
authors.lastname: Weisel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D003907:Dexamethasone / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006801:Humans; D000077269:Lenalidomide; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications* / Q000188:drug therapy* / Q000401:mortality; D012008:Recurrence; D051437:Renal Insufficiency / Q000150:complications*; D012189:Retrospective Studies; D013792:Thalidomide / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D013792:Thalidomide; D003907:Dexamethasone; D000077269:Lenalidomide