title: Bortezomib-based therapy combined with high cut-off hemodialysis is highly effective in newly diagnosed multiple myeloma patients with severe renal impairment.
abstract: Multiple myeloma (MM) is often associated with renal insufficiency (RI) which adversely influences the prognosis. Several studies demonstrated that bortezomib can improve both renal function and outcome. We prospectively evaluated 21 newly diagnosed MM patients with severe renal impairment secondary to tubular-interstitial damage, most of them due to myeloma kidney, who were primarily treated with bortezomib-based therapy combined with high cut-off hemodialysis (HCOD). The median serum creatinine level at baseline was 6.44 mg dL(-1) and calculated median estimated glomerular filtration rate (eGFR), according to Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) creatinine equation, was 8 mL/min/1.73 m(2) . Serum free light chain (sFLC) median concentration was 6,040 mg L(-1) . Post induction and best stringent complete response rates were 19 and 38%, respectively. Responses were fast, occurring within a median of 1.4 months. The combination of bortezomib and HCOD led to a prompt and remarkable (>90%) decrease in sFLC levels. Sixteen patients (76%) became dialysis independent within a median of 32 days. With a median follow up of 17.2 months, the 3-year PFS and OS were 76 and 67%, respectively. No early deaths were observed. This study demonstrates that incorporation of bortezomib into induction therapy combined with HCOD is a highly effective strategy in rescuing renal function and improving outcomes in patients with MM and RI.
authors: "Seràgnoli" Institute of Hematology, Department of Experimental, Diagnostic and Specialty Medicine Bologna, University School of Medicine, Sant'Orsola-Malpighi University Hospital, Bologna, Italy.
authors: Beatrice Anna
authors: BA
authors: Zannetti
authors: "Seràgnoli" Institute of Hematology, Department of Experimental, Diagnostic and Specialty Medicine Bologna, University School of Medicine, Sant'Orsola-Malpighi University Hospital, Bologna, Italy.
authors: Elena
authors: E
authors: Zamagni
authors: Nephrology, Dialysis, and Hypertension Unit, Sant'Orsola-Malpighi University Hospital, Bologna, Italy.
authors: Marisa
authors: M
authors: Santostefano
authors: Nephrology, Dialysis, and Hypertension Unit, Sant'Orsola-Malpighi University Hospital, Bologna, Italy.
authors: Lucia Barbara
authors: LB
authors: De Sanctis
authors: "Seràgnoli" Institute of Hematology, Department of Experimental, Diagnostic and Specialty Medicine Bologna, University School of Medicine, Sant'Orsola-Malpighi University Hospital, Bologna, Italy.
authors: Paola
authors: P
authors: Tacchetti
authors: Nephrology, Dialysis, and Hypertension Unit, Sant'Orsola-Malpighi University Hospital, Bologna, Italy.
authors: Elena
authors: E
authors: Mancini
authors: "Seràgnoli" Institute of Hematology, Department of Experimental, Diagnostic and Specialty Medicine Bologna, University School of Medicine, Sant'Orsola-Malpighi University Hospital, Bologna, Italy.
authors: Lucia
authors: L
authors: Pantani
authors: "Seràgnoli" Institute of Hematology, Department of Experimental, Diagnostic and Specialty Medicine Bologna, University School of Medicine, Sant'Orsola-Malpighi University Hospital, Bologna, Italy.
authors: Annamaria
authors: A
authors: Brioli
authors: Nephrology, Dialysis, and Hypertension Unit, Sant'Orsola-Malpighi University Hospital, Bologna, Italy.
authors: Raffaella
authors: R
authors: Rizzo
authors: "Seràgnoli" Institute of Hematology, Department of Experimental, Diagnostic and Specialty Medicine Bologna, University School of Medicine, Sant'Orsola-Malpighi University Hospital, Bologna, Italy.
authors: Katia
authors: K
authors: Mancuso
authors: "Seràgnoli" Institute of Hematology, Department of Experimental, Diagnostic and Specialty Medicine Bologna, University School of Medicine, Sant'Orsola-Malpighi University Hospital, Bologna, Italy.
authors: Serena
authors: S
authors: Rocchi
authors: "Seràgnoli" Institute of Hematology, Department of Experimental, Diagnostic and Specialty Medicine Bologna, University School of Medicine, Sant'Orsola-Malpighi University Hospital, Bologna, Italy.
authors: Annalisa
authors: A
authors: Pezzi
authors: "Seràgnoli" Institute of Hematology, Department of Experimental, Diagnostic and Specialty Medicine Bologna, University School of Medicine, Sant'Orsola-Malpighi University Hospital, Bologna, Italy.
authors: Enrica
authors: E
authors: Borsi
authors: "Seràgnoli" Institute of Hematology, Department of Experimental, Diagnostic and Specialty Medicine Bologna, University School of Medicine, Sant'Orsola-Malpighi University Hospital, Bologna, Italy.
authors: Carolina
authors: C
authors: Terragna
authors: "Seràgnoli" Institute of Hematology, Department of Experimental, Diagnostic and Specialty Medicine Bologna, University School of Medicine, Sant'Orsola-Malpighi University Hospital, Bologna, Italy.
authors: Giulia
authors: G
authors: Marzocchi
authors: Nephrology, Dialysis, and Hypertension Unit, Sant'Orsola-Malpighi University Hospital, Bologna, Italy.
authors: Antonio
authors: A
authors: Santoro
authors: "Seràgnoli" Institute of Hematology, Department of Experimental, Diagnostic and Specialty Medicine Bologna, University School of Medicine, Sant'Orsola-Malpighi University Hospital, Bologna, Italy.
authors: Michele
authors: M
authors: Cavo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001897:Boronic Acids / Q000627:therapeutic use*; D000069286:Bortezomib; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007147:Immunoglobulin Light Chains / Q000097:blood; D060828:Induction Chemotherapy; D007668:Kidney / Q000187:drug effects* / Q000276:immunology / Q000473:pathology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications / Q000188:drug therapy* / Q000276:immunology / Q000503:physiopathology; D011719:Pyrazines / Q000627:therapeutic use*; D012074:Remission Induction; D006435:Renal Dialysis / Q000379:methods*; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000188:drug therapy* / Q000276:immunology / Q000503:physiopathology; D016019:Survival Analysis
chemical_list: D000970:Antineoplastic Agents; D001897:Boronic Acids; D007147:Immunoglobulin Light Chains; D011719:Pyrazines; D000069286:Bortezomib; D003404:Creatinine