Newly Diagnosed Multiple Myeloma and Renal (Dys)Function

By Suzanne Morris, DVMReviewed by Catherine Lai, MD, MPH, Director of Leukemia, Assistant Professor, Georgetown University Medical Center, Lombardi Comprehensive Cancer Center

During the first 12 months following a diagnosis of multiple myeloma (MM), a relatively small number of patients experienced significantly decreased renal function, a new study has found.1

Approximately 50% of patients who first present with MM also have renal impairment (RI), one of the common complications of MM. The underlying pathology of RI is frequently myeloma cast

nephropathy (MCN), resulting from an excess of monoclonal serum free light chain (sFLC).2,3

However, it’s unknown what proportion of patients with RI have MCN and, more generally, how RI affects patient outcomes in the current MM treatment setting.1 Hence, there remains a lack of

clarity regarding the natural history of RI in patients with MM.

“Defining the contribution of kidney disease stratified by severity on outcomes will inform discussions around future therapy choices and overall long-term prognosis,” explained Ritika Rana,

MD, of University Hospitals Birmingham NHS Foundation Trust, Birmingham, U.K., and colleagues in Blood Advances.1

The phase 3, randomized, open-label Myeloma XI trial evaluated combinations of lenalidomide, thalidomide, bortezomib, and carfilzomib in addition to maintenance lenalidomide ± vorinostat in

4420 patients with newly diagnosed MM (NDMM).1 The renal function of 2334 trial patients was evaluated at baseline and again at 12 months. The trial’s parallel group design involved 2

treatment courses: intensive and non-intensive. The intensive treatment group comprised younger patients appropriate for high-dose therapy and stem cell transplantation, whereas the

non-intensive group was assessed as inappropriate for transplantation. Within each group, patients were randomized to receive induction therapy with cyclophosphamide, lenalidomide, and

dexamethasone (CRD) or cyclophosphamide, thalidomide, and dexamethasone (CTD). Patients with a suboptimal response might also receive an intensification regimen of cyclophosphamide,

bortezomib, and dexamethasone (CVD).

Patients who were ≥18 years old and newly diagnosed with symptomatic myeloma were included. Exclusions were dialysis at presentation or a diagnosis of acute kidney injury. Serum creatinine,

estimated glomerular filtration rate (eGFR), and sFLC were measured at baseline and at 12 ± 3 months, and renal function was stratified by eGFR >59 mL/min/1.73 m2, 30 to 59 mL/min/1.73 m2,

and