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P-115: Renal response to rescue treatments in Relapsed Refractory Multiple Myeloma (RRMM) patients with renal impairment: final data of a large, observational, prospective study (MIR50)
Ist Teil von
Clinical lymphoma, myeloma and leukemia, 2021-10, Vol.21, p.S97-S98
Ort / Verlag
Elsevier Inc
Erscheinungsjahr
2021
Link zum Volltext
Quelle
Elsevier ScienceDirect Journals Complete
Beschreibungen/Notizen
Renal impairment (RI) is a common complication of multiple myeloma (MM) and has been associated with poor survival. MIR50 is an observational, prospective, multicenter study aimed to evaluate the renal response (RR) to treatment in patients (pts) with RRMM.
Renal and MM responses are evaluated according to IMWG criteria in pts with moderate RI (mRI;CrCl 30–50mL/min) or severe RI (sRI;CrCl<30mL/min). Besides, estimated glomerular filtration rate (eGFR) by the Cockroft-Gault (CG), Modification of Diet in Renal Disease(MDRD) and Chronic Kidney Disease Epidemiology Collaboration(CKD-EPI) formulas were compared to analyze renal function.
We included 282 pts with a median (range) of 76 (70-81) yo (52% male, 44% ISS3, 40% in 2nd or later relapse). Overall, 181(64%) pts had mRI and 100(36%) pts had sRI. Arterial hypertension (HT) was the most frequent comorbidity. Patients with sRI, compared with mRI, had a more advanced phase of MM, BJ type MM, ISS3 disease, HR cytogenetic, diabetes mellitus, and primary malignancies other than MM. Pts were treated with lenalidomide (LEN) (109,43,8%) or bortezomib (BORT)-based treatment (61,24,5%),respectively. Median follow-up was 15.2(range,7.2-33.8) months(mo). Overall response rate was 49.0% w/o differences in renal subgroups (mRI:48.5%;sRI:50.0%). Basal renal function (mean[SD]) at rescue treatment initiation was very similar for the three equations (CG:33.1[11.5], MDRD:35.1[14.3], CKD-EPI:34.7[14.4]mL/min/1.73m2). RR was 20.8%(CG), 27.3%(MDRD), and 27.3%(CKD-EPI) with a moderate correlation between CG and either MDRD(ρ=0,90) or CKD-EPI(ρ=0,92), while agreement between MDRD and CKD-EPI equations was almost perfect(ρ=0,99). The only factor to negatively influence the improvement in renal function in multivariate analysis was HT(p=0.02). During follow-up 88(35.3%) pts developed acute kidney injury (AKI), more frequently observed among patients with sRI (51.2% vs 27% in mRI). Only 16(18.2%) pts recovered from AKI. PFS and OS in the overall series was 8.3 (6.8-11.1) and 20.9(16.1-27.1) mo, respectively w/o differences according to renal subgroups. The main cause of death was disease progression (49.1%). Median (95%CI) PFS and OS were significantly different among rescue treatments (p<0.0001 both), being 13.3(9.6-15.7) and 28.8(21.4-36.5) mo for LEN, 8.5(5.5-12.0) and 24.8(16.1-33.8) mo for BORT, and 5.7(4.4-7.7) and 9.9(7.7-16.8) mo for other therapies. Finally, OS was significantly shorter in patients who developed AKI compared to those who did not (55.1[45.6-70.2] vs 71.7[62.6-83.8] mo,p=0.01).
This study shows that HT was the most frequent comorbidity in pts with RRMM and RI. Patients with CrCl <30mL/min had a more advanced phase of MM, BJ type MM, ISS3 disease, and high-risk cytogenetic. In addition, these patients develop AKI more frequently, associating an unfavourable impact on OS. LEN- and BORT-based treatments can improve RI in approximately 20-27% of pts.