Friederike Bachmann1, Martin Schreder2, Monika Engelhardt3, Christian Langer4, Denise Wolleschak5, Lars Olof Mügge6, Heinz Dürk7, Kerstin Schäfer-Eckart8, Igor Wolfgang Blau9, Martin Gramatzki10, Peter Liebisch11, Matthias Grube12, Ivana V Metzler13, Florian Bassermann14, Bernd Metzner15, Christoph Röllig16, Bernd Hertenstein17, Cyrus Khandanpour18, Tobias Dechow19, Holger Hebart20, Wolfram Jung21, Sebastian Theurich22, Georg Maschmeyer23, Hans Salwender24, Georg Hess25, Max Bittrich2, Leo Rasche2, Annamaria Brioli6, Kai-Uwe Eckardt1, Christian Straka26, Swantje Held27, Hermann Einsele2, Stefan Knop2. 1. Division of Nephrology and Medical Intensive Care, Charité University Medicine, 10117 Berlin, Germany. 2. Division of Hematology and Oncology, Würzburg University Hospital Medical Center, 97080 Würzburg, Germany. 3. Freiburg University Hospital, 79106 Freiburg, Germany. 4. Ulm University Hospital, 89070 Ulm, Germany. 5. Magdeburg University Hospital, 39120 Magdeburg, Germany. 6. Jena University Hospital, 07747 Jena, Germany. 7. St. Barbara- Hospital Hamm GmbH, 59075 Hamm, Germany. 8. Nuremberg Hospital, Paracelsus Medizinische Privatuniversität, 90419 Nuremberg, Germany. 9. Division of Hematology and Immunology, Charité University Medicine, 13353 Berlin, Germany. 10. Schleswig-Holstein University Hospital, Kiel Campus, 24105 Kiel, Germany. 11. Private Oncology Practice, 47441 Moers, Germany. 12. Regensburg University Hospital, 93043 Regensburg, Germany. 13. Frankfurt University Hospital, 60590 Frankfurt, Germany. 14. University Hospital re. d. Isar, 81675 Munich, Germany. 15. Oldenburg University Hospital, 26133 Oldenburg, Germany. 16. Dresden Carl Gustav Carus University Hospital, 01307 Dresden, Germany. 17. Bremen Municipal Hospital Mitte, 28205 Bremen, Germany. 18. Munster University Hospital, 48149 Munster, Germany. 19. Private Oncology Practice, 88212 Ravensburg, Germany. 20. Stauferklinikum, Schwäbisch Gmünd, 73557 Mutlangen, Germany. 21. Göttingen University Hospital, 37099 Göttingen, Germany. 22. Munich Großhadern University Hospital, 80336 Munich, Germany. 23. Ernst von Bergmann Hospital, 14467 Potsdam, Germany. 24. Asklepios Klinikum Altona, 22763 Hamburg, Germany. 25. Mainz University Hospital, 55131 Mainz, Germany. 26. Munich Hospital Schwabing, 80804 Munich, Germany. 27. Department of Biostatistics at ClinAssess GmbH, 51379 Leverkusen, Germany.
Abstract
BACKGROUND: Preservation of kidney function in newly diagnosed (ND) multiple myeloma (MM) helps to prevent excess toxicity. Patients (pts) from two prospective trials were analyzed, provided postinduction (PInd) restaging was performed. Pts received three cycles with bortezomib (btz), cyclophosphamide, and dexamethasone (dex; VCD) or btz, lenalidomide (len), and dex (VRd) or len, adriamycin, and dex (RAD). The minimum required estimated glomerular filtration rate (eGFR) was >30 mL/min. We analyzed the percent change of the renal function using the International Myeloma Working Group (IMWG) criteria and Kidney Disease: Improving Global Outcomes (KDIGO)-defined categories. RESULTS: Seven hundred and seventy-two patients were eligible. Three hundred and fifty-six received VCD, 214 VRd, and 202 RAD. VCD patients had the best baseline eGFR. The proportion of pts with eGFR <45 mL/min decreased from 7.3% at baseline to 1.9% PInd (p < 0.0001). Thirty-seven point one percent of VCD versus 49% of VRd patients had a decrease of GFR (p = 0.0872). IMWG-defined "renal complete response (CRrenal)" was achieved in 17/25 (68%) pts after VCD, 12/19 (63%) after RAD, and 14/27 (52%) after VRd (p = 0.4747). CONCLUSIONS: Analyzing a large and representative newly diagnosed myeloma (NDMM) group, we found no difference in CRrenal that occurred independently from the myeloma response across the three regimens. A trend towards deterioration of the renal function with VRd versus VCD may be explained by a better pretreatment "renal fitness" in the latter group.
BACKGROUND: Preservation of kidney function in newly diagnosed (ND) multiple myeloma (MM) helps to prevent excess toxicity. Patients (pts) from two prospective trials were analyzed, provided postinduction (PInd) restaging was performed. Pts received three cycles with bortezomib (btz), cyclophosphamide, and dexamethasone (dex; VCD) or btz, lenalidomide (len), and dex (VRd) or len, adriamycin, and dex (RAD). The minimum required estimated glomerular filtration rate (eGFR) was >30 mL/min. We analyzed the percent change of the renal function using the International Myeloma Working Group (IMWG) criteria and Kidney Disease: Improving Global Outcomes (KDIGO)-defined categories. RESULTS: Seven hundred and seventy-two patients were eligible. Three hundred and fifty-six received VCD, 214 VRd, and 202 RAD. VCDpatients had the best baseline eGFR. The proportion of pts with eGFR <45 mL/min decreased from 7.3% at baseline to 1.9% PInd (p < 0.0001). Thirty-seven point one percent of VCD versus 49% of VRdpatients had a decrease of GFR (p = 0.0872). IMWG-defined "renal complete response (CRrenal)" was achieved in 17/25 (68%) pts after VCD, 12/19 (63%) after RAD, and 14/27 (52%) after VRd (p = 0.4747). CONCLUSIONS: Analyzing a large and representative newly diagnosed myeloma (NDMM) group, we found no difference in CRrenal that occurred independently from the myeloma response across the three regimens. A trend towards deterioration of the renal function with VRd versus VCD may be explained by a better pretreatment "renal fitness" in the latter group.