title: Improvement in renal function and its impact on survival in patients with newly diagnosed multiple myeloma.
abstract: Renal impairment (RI) is seen in over a quarter of patients with newly diagnosed multiple myeloma (NDMM). It is not clear if reversal of RI improves the outcome to that expected for NDMM patients without RI. We evaluated 1135 consecutive patients with NDMM seen at the Mayo Clinic between January 2003 and December 2012. RI was defined as having a creatinine clearance (CrCl) <40ml/min. The median overall survival (OS) for patients with RI at diagnosis receiving and not receiving novel agent induction therapy was not reached vs 46 months (P<0.001). The median OS for patients with CrCl ⩾40 ml/min at diagnosis, CrCl <40 ml/min at diagnosis but improved to ⩾40 ml/min and CrCl <40 ml/min at diagnosis and remained <40 ml/min, were 112, 56 and 33 months, respectively (P<0.001). The complete renal response rate for patients with RI at diagnosis receiving novel agent induction therapy compared to the rest was 40 vs 16% (P<0.001). In conclusion, patients with reversal of RI have improved outcomes, but it remains inferior to patients with normal renal function at diagnosis. These results have implications for identifying early treatment strategies for patients at risk of developing renal insufficiency.
authors: Divisions of Hematology and Nephrology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
authors: W I
authors: WI
authors: Gonsalves
authors: Divisions of Hematology and Nephrology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
authors: N
authors: N
authors: Leung
authors: Divisions of Hematology and Nephrology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
authors: S V
authors: SV
authors: Rajkumar
authors: Divisions of Hematology and Nephrology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
authors: A
authors: A
authors: Dispenzieri
authors: Divisions of Hematology and Nephrology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
authors: M Q
authors: MQ
authors: Lacy
authors: Divisions of Hematology and Nephrology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
authors: S R
authors: SR
authors: Hayman
authors: Divisions of Hematology and Nephrology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
authors: F K
authors: FK
authors: Buadi
authors: Divisions of Hematology and Nephrology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
authors: D
authors: D
authors: Dingli
authors: Divisions of Hematology and Nephrology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
authors: P
authors: P
authors: Kapoor
authors: Divisions of Hematology and Nephrology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
authors: R S
authors: RS
authors: Go
authors: Divisions of Hematology and Nephrology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
authors: Y
authors: Y
authors: Lin
authors: Divisions of Hematology and Nephrology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
authors: S J
authors: SJ
authors: Russell
authors: Divisions of Hematology and Nephrology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
authors: J A
authors: JA
authors: Lust
authors: Divisions of Hematology and Nephrology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
authors: S
authors: S
authors: Zeldenrust
authors: Divisions of Hematology and Nephrology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
authors: R A
authors: RA
authors: Kyle
authors: Divisions of Hematology and Nephrology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
authors: M A
authors: MA
authors: Gertz
authors: Divisions of Hematology and Nephrology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
authors: S K
authors: SK
authors: Kumar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D003582:Cytogenetics; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D051437:Renal Insufficiency / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology* / Q000473:pathology; D016896:Treatment Outcome