PURPOSE: To assess the efficacy of bortezomib-doxorubicin-dexamethasone (BDD) therapy in patients with multiple myeloma with light chain-induced acute renal failure. PATIENTS AND METHODS: Sixty-eight patients with light chain-induced acute renal failure and glomerular filtration rate (GFR) less than 50 mL/min received bortezomib (1.0 mg/m(2) on days 1, 4, 8, and 11), doxorubicin (9 mg/m(2) on days 1 and 4), and dexamethasone (40 mg on days 1, 4, 8, and 11); if well tolerated after two cycles, bortezomib could be increased to 1.3 mg/m(2) and doxorubicin administered on days 1, 4, 8, and 11. RESULTS: By intent-to-treat analysis a myeloma response was obtained in 72% of 18 previously and 50 not previously treated patients (complete response [CR]/near CR [nCR], 38%; very good partial response [VGPR], 15%; partial response [PR], 13%; minor response [MR], 6%). Renal response was achieved in 62% of patients (renal CR, 31%; renal PR, 7%; renal MR, 24%). Median GFR increased from 20.5 to 48.4 mL/min. GFR improvement correlated with tumor response; the greatest increase to 59.6 mL/min was seen in the group of patients with CR/nCR/VGPR. Median progression-free survival was 12.1 months. One- and 2-year survival rates were 72% and 58%, respectively. Survival did not differ between patients with and without renal response but was inferior in previously treated patients (P < .001). In multivariate analysis, baseline GFR and tumor response correlated with renal response, and pretreatment status, lactate dehydrogenase, and myeloma response correlated with survival. The most common grade 3 or 4 toxicities were infection (19.1%), thrombocytopenia (14.7%), neutropenia (14.7%), fatigue/weakness (10.3%), and polyneuropathy (8.8%). CONCLUSION: BDD induced a high rate of myeloma and renal responses, and treatment was well tolerated.
PURPOSE: To assess the efficacy of bortezomib-doxorubicin-dexamethasone (BDD) therapy in patients with multiple myeloma with light chain-induced acute renal failure. PATIENTS AND METHODS: Sixty-eight patients with light chain-induced acute renal failure and glomerular filtration rate (GFR) less than 50 mL/min received bortezomib (1.0 mg/m(2) on days 1, 4, 8, and 11), doxorubicin (9 mg/m(2) on days 1 and 4), and dexamethasone (40 mg on days 1, 4, 8, and 11); if well tolerated after two cycles, bortezomib could be increased to 1.3 mg/m(2) and doxorubicin administered on days 1, 4, 8, and 11. RESULTS: By intent-to-treat analysis a myeloma response was obtained in 72% of 18 previously and 50 not previously treated patients (complete response [CR]/near CR [nCR], 38%; very good partial response [VGPR], 15%; partial response [PR], 13%; minor response [MR], 6%). Renal response was achieved in 62% of patients (renal CR, 31%; renal PR, 7%; renal MR, 24%). Median GFR increased from 20.5 to 48.4 mL/min. GFR improvement correlated with tumor response; the greatest increase to 59.6 mL/min was seen in the group of patients with CR/nCR/VGPR. Median progression-free survival was 12.1 months. One- and 2-year survival rates were 72% and 58%, respectively. Survival did not differ between patients with and without renal response but was inferior in previously treated patients (P < .001). In multivariate analysis, baseline GFR and tumor response correlated with renal response, and pretreatment status, lactate dehydrogenase, and myeloma response correlated with survival. The most common grade 3 or 4 toxicities were infection (19.1%), thrombocytopenia (14.7%), neutropenia (14.7%), fatigue/weakness (10.3%), and polyneuropathy (8.8%). CONCLUSION:BDD induced a high rate of myeloma and renal responses, and treatment was well tolerated.
Authors: Colin A Hutchison; Paul Cockwell; Stephanie Stringer; Arthur Bradwell; Mark Cook; Morie A Gertz; Angela Dispenzieri; Jeffrey L Winters; Shaji Kumar; S Vincent Rajkumar; Robert A Kyle; Nelson Leung Journal: J Am Soc Nephrol Date: 2011-04-21 Impact factor: 10.121
Authors: S K Kumar; E Ma; A E Engebretson; F K Buadi; M Q Lacy; A Dispenzieri; M S Duh; M-H Lafeuille; P Lefebvre; W Y Cheng; K Dea; D Rembert; D Patt; L Niculescu; M Quick; S V Rajkumar Journal: Leukemia Date: 2015-08-14 Impact factor: 11.528
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Authors: Heinz Ludwig; Pieter Sonneveld; Faith Davies; Joan Bladé; Mario Boccadoro; Michele Cavo; Gareth Morgan; Javier de la Rubia; Michel Delforge; Meletios Dimopoulos; Hermann Einsele; Thierry Facon; Hartmut Goldschmidt; Philippe Moreau; Hareth Nahi; Torben Plesner; Jesús San-Miguel; Roman Hajek; Pia Sondergeld; Antonio Palumbo Journal: Oncologist Date: 2014-07-25
Authors: H Ludwig; J S Miguel; M A Dimopoulos; A Palumbo; R Garcia Sanz; R Powles; S Lentzsch; W Ming Chen; J Hou; A Jurczyszyn; K Romeril; R Hajek; E Terpos; K Shimizu; D Joshua; V Hungria; A Rodriguez Morales; D Ben-Yehuda; P Sondergeld; E Zamagni; B Durie Journal: Leukemia Date: 2013-10-09 Impact factor: 11.528