Autologous hematopoietic cell transplantation for multiple myeloma patients with renal insufficiency: a center for international blood and marrow transplant research analysis

• Published in: Bone marrow transplantation (Basingstoke) Vol. 52; no. 12; pp. 1616 - 1622
• Main Authors: Mahindra, A, Hari, P, Fraser, R, Fei, M, Huang, J, Berdeja, J, Callander, N, Costa, L, Diaz, M A, Freytes, C, Gale, R P, Girnius, S, Holmberg, L, Kharfan-Dabaja, M, Kumar, S, Kyle, R, Lazarus, H, Lee, C, Maiolino, A, Moreb, J, Nishihori, T, Pawarode, A, Saad, A, Savani, B N, Schriber, J, William, B, Wirk, B M, Krishnan, A, Nieto, Y, D’Souza, A
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01-12-2017; Nature Publishing Group
• Subjects: 692/308/174; 692/699/1541/1990/804; Autografts; Bone marrow; Bone marrow transplantation; Care and treatment; Cell Biology; Chemotherapy; Diagnosis; Dialysis; Hematology; Hematopoietic stem cell transplantation; Internal Medicine; Kidney transplantation; Medicine; Medicine & Public Health; Melphalan; Multiple myeloma; original-article; Patients; Public Health; Renal insufficiency; Stem cell transplantation; Stem Cells; Transplantation; Transplants & implants
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/bmt.2017.198

Autologous hematopoietic cell transplantation (AHCT) in multiple myeloma (MM) patients with renal insufficiency (RI) is controversial. Patients who underwent AHCT for MM between 2008 and 2013 were identified (
N
=1492) and grouped as normal/mild (⩾60 mL/min),
N
=1240, moderate (30–59),
N
=185 and severe RI (<30),
N
=67 based on Modification of Diet in Renal Disease. Multivariate analyses of non-relapse mortality (NRM), relapse, PFS and overall survival (OS) were performed. Of the 67 patients with severe RI, 35 were on dialysis prior to AHCT. Patients received melphalan 200 mg/m
2
(Mel 200) in 92% (normal/mild), 75% (moderate) and 33% (severe) RI; remainder received 140 mg/m
2
(Mel 140). Thirty four of 35 patients with severe RI achieved post-AHCT dialysis independence. The 5-year PFS for normal, moderate and severe RI was 35 (95% CI, 31–38)%, 40 (31–49)% and 27 (15–40)%, respectively, (
P
=0.42); 5-year OS for normal, moderate and severe RI was 68 (65–71)%, 68 (60–76)% and 60 (46–74)%, respectively, (
P
=0.69). With moderate RI, 5-year PFS for high-dose melphalan 140 mg/m
2
was 18 (6–35)% and for Mel 200 was 46 (36–57)% (
P
=0.009). With severe RI, 5-year PFS Mel 140 was 25 (11–41) % and for Mel 200 was 32 (11–58)% (
P
=0.37). We conclude that AHCT is safe and effective in patients with MM with RI.