Treatment outcomes in patients with newly diagnosed multiple myeloma complicated by severe renal failure requiring hemodialysis

   Background. Renal failure (RF) is the most common complication of multiple myeloma (MM), and severe RF requiring hemodialysis is diagnosed in 2–4 % of cases. RF associated with MM is potentially reversible. Severe RF requiring hemodialysis is associated with low overall survival rates, increased risk of complications and early death, low quality of life for patients.

   Aim. To analyze treatment results of newly diagnosed MM patients with severe RF requiring hemodialysis.

   Materials and methods. We analyzed data of 39 patients with newly diagnosed MM and severe RF requiring hemodialysis (CKD-EPI < 15 mL/min/1.73 m²) who underwent combination therapy at the N.N. Blokhin National Medical Research Center of Oncology between January 2000 and December 2020.

   Results. As induction therapy, 25 (64.1 %) patients received bortezomib-based regimens: 13 (33.3 %), VCD (bortezomib + cyclophosphamide + dexamethasone); 12 (30.8 %), VCP (bortezomib + cyclophosphamide + prednisolone); 14 (35.9 %) patients received chemotherapy: VAD (vincristine + doxorubicin + prednisolone), VMCP (vincristine + melphalan + cyclophosphamide + prednisolone), CD (cyclophosphamide + prednisolone). Seven (17.9 %) patients underwent high-dose chemotherapy followed by autologous hematopoietic stem cell transplantation, 5 (71.4 %) patients from this group received bortezomib-based regimens (VCD, VCP), and 2 (28.6 %) – chemotherapy (VAD). After induction therapy, 19 (48.7 %) patients achieved objective hematologic response, and 23 (59 %) patients achieved objective renal response. The use of bortezomib-based induction therapy significantly increased the likelihood of achieving both hematologic and renal responses (p = 0.021 and p = 0.049, respectively) compared with the use of regimens without bortezomib. With a median follow-up of 19 months (95 % confidence interval 1–64 months), median progression-free survival was 15 months (95 % confidence interval: 8–26 months), median overall survival was 29 months (95 % confidence interval: 9–47 months). Multivariate analysis showed statistical significance of the effect of receiving autologous hematopoietic stem cell transplantation on progression-free survival and overall survival (p = 0.015 and p = 0.018, respectively).

   Conclusion. Using bortezomib-based regimens in newly diagnosed MM patients with severe RF requiring hemodialysis is associated with greater likelihood of achieving both hematologic and renal responses. Performing autologous hematopoietic stem cell transplantation improves progression-free survival and overall survival.

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