The implication of compromised renal function at presentation in myeloma. Similar outcome in patients who receive high-dose therapy: A single-center study of 251 previously untreated patients

B. Sirohi, R. Powles*, J. Mehta, J. Treleaven, N. Raje, S. Kulkarni, C. Rudin, N. Bhagwati, C. Horton, R. Saso, S. Singhal, P. Parikh

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

17 Scopus citations

Abstract

The purpose of the study was to determine the role of sequential therapy (ST) in new patients with myeloma presenting with renal dysfunction (RD): serum creatinine >140 gmol/L (1.6 mg/dL). Between April 1985 and June 1998, 251 patients, 59 (23%) with RD were entered into a ST program comprised of infusional chemotherapy (IC) with VAMP/C-VAMP (vincristine, doxorubicin, and methylprednisolone with/without cyclophosphamide) followed by autologous transplantation and interferon maintenance. The median overall survival (OS) of 251 patients from the start of IC was 4.2 yr with the RD group faring significantly poorer (median 2.5 yr) than those with no renal dysfunction (NRD; median 4.6 yr; p=0.0025). Mortality during the first 100 d of IC was significantly higher in patients with RD (11/59; p=0.01) compared to patients with NRD. In patients consolidated with high-dose therapy, the OS and event-free survival (EFS) were not significantly different between the two groups. Cox analysis of the variables at presentation failed to show RD as a factor influencing outcome, but it showed that patients with beta-2-microglobulin (β2M) ≥3.7 (p < 0.0001), age ≥52.5 yr (p=0.002), performance status (PS) ≥2 (p=0.005) and patients with light-chain myeloma (p=0.03) had a significantly shorter OS, β2M ≥ 3.7, PS ≥ 2, and light-chain myeloma were predictive of shorter EFS. The study shows that with modern intensive schedules of treatment, renal disease at presentation in isolation does not compromise outcome.

Original languageEnglish (US)
Pages (from-to)39-50
Number of pages12
JournalMedical Oncology
Volume18
Issue number1
DOIs
StatePublished - 2001

Keywords

  • Myeloma
  • Outcome
  • Renal function
  • Sequential therapy

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Cancer Research

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