Autologous hematopoietic cell transplantation for multiple myeloma patients with renal insufficiency

A center for international blood and marrow transplant research analysis

A. Mahindra, P. Hari, R. Fraser, M. Fei, J. Huang, J. Berdeja, N. Callander, L. Costa, M. A. Diaz, C. Freytes, R. P. Gale, S. Girnius, L. Holmberg, M. Kharfan-Dabaja, Shaji K Kumar, R. Kyle, H. Lazarus, C. Lee, A. Maiolino, J. Moreb & 10 others T. Nishihori, A. Pawarode, A. Saad, B. N. Savani, J. Schriber, B. William, B. M. Wirk, A. Krishnan, Y. Nieto, A. D'Souza

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

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 (≤3/460 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.

Original languageEnglish (US)
Pages (from-to)1616-1622
Number of pages7
JournalBone Marrow Transplantation
Volume52
Issue number12
DOIs
StatePublished - Dec 1 2017

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Cell Transplantation
Multiple Myeloma
Renal Insufficiency
Bone Marrow
Transplants
Research
Melphalan
Dialysis
Diet Therapy
Survival
Multivariate Analysis
Kidney
Recurrence
Mortality

ASJC Scopus subject areas

  • Hematology
  • Transplantation

Cite this

Autologous hematopoietic cell transplantation for multiple myeloma patients with renal insufficiency : A center for international blood and marrow transplant research analysis. / 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, Shaji K; 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.

In: Bone Marrow Transplantation, Vol. 52, No. 12, 01.12.2017, p. 1616-1622.

Research output: Contribution to journalArticle

Mahindra, A, Hari, P, Fraser, R, Fei, M, Huang, J, Berdeja, J, Callander, N, Costa, L, Diaz, MA, Freytes, C, Gale, RP, Girnius, S, Holmberg, L, Kharfan-Dabaja, M, Kumar, SK, Kyle, R, Lazarus, H, Lee, C, Maiolino, A, Moreb, J, Nishihori, T, Pawarode, A, Saad, A, Savani, BN, Schriber, J, William, B, Wirk, BM, Krishnan, A, Nieto, Y & D'Souza, A 2017, 'Autologous hematopoietic cell transplantation for multiple myeloma patients with renal insufficiency: A center for international blood and marrow transplant research analysis', Bone Marrow Transplantation, vol. 52, no. 12, pp. 1616-1622. https://doi.org/10.1038/bmt.2017.198
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, Shaji K ; 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. / Autologous hematopoietic cell transplantation for multiple myeloma patients with renal insufficiency : A center for international blood and marrow transplant research analysis. In: Bone Marrow Transplantation. 2017 ; Vol. 52, No. 12. pp. 1616-1622.
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abstract = "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 (≤3/460 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.",
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T2 - A center for international blood and marrow transplant research analysis

AU - Mahindra, A.

AU - Hari, P.

AU - Fraser, R.

AU - Fei, M.

AU - Huang, J.

AU - Berdeja, J.

AU - Callander, N.

AU - Costa, L.

AU - Diaz, M. A.

AU - Freytes, C.

AU - Gale, R. P.

AU - Girnius, S.

AU - Holmberg, L.

AU - Kharfan-Dabaja, M.

AU - Kumar, Shaji K

AU - Kyle, R.

AU - Lazarus, H.

AU - Lee, C.

AU - Maiolino, A.

AU - Moreb, J.

AU - Nishihori, T.

AU - Pawarode, A.

AU - Saad, A.

AU - Savani, B. N.

AU - Schriber, J.

AU - William, B.

AU - Wirk, B. M.

AU - Krishnan, A.

AU - Nieto, Y.

AU - D'Souza, A.

PY - 2017/12/1

Y1 - 2017/12/1

N2 - 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 (≤3/460 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.

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