Reversal of Renal Insufficiency after Autologous Stem Cell Transplantation in Patients with Multiple Myeloma
Authors: Tuncer Hande Hayirlioglu , Maciejewski John J. , Gregory Stephanie A , Fung Henry C. 
Published: April 2020

High dose chemotherapy followed by autologous stem cell transplantation (SCT) prolongs survival and is the standard of care for eligible multiple myeloma patients. Approximately 50 % of patients presented with renal insufficiency and 20% have renal failure at diagnosis. Transplant eligibility of patients with renal insufficiency is controversial due to the concerns of increased toxicity. We retrospectively evaluated 80 patients with multiple myeloma who underwent either single or tandem SCT at Rush University Medical Center between January 1999 and December 2003. Median OS was 51 months and PFS was 26 months for all patients. All patients with renal insufficiency except those who did not have change in renal function had SCT within 12 months of initial diagnosis. Ten (12 %) patients had serum creatinine of at least 1.5mg/dl immediately before the transplantation. (mean creatinine: 2.88 mg/dl, range 1.4–4.9mg/dl) All patients with renal insufficiency except one had positive urine immunofixation for free light chains (6 kappa and 3 lambda) and all had normal serum calcium level at the time of SCT. GFR was estimated by MDRD equation. Three out of ten (30%) patients had at least 100% improvement in GFR by day 30 post-transplant (mean decrease in serum creatinine 1.26 mg/dl, range 1.1–2.9 mg/dl). Four (40%) patients had at least 50% increase in GFR after day 100. (mean decrease in serum creatinine 1.48mg/dl, range 1–2.9 mg/dl ). Two (20%) patients had no significant change in renal function (pre-transplant mean serum creatinine 2.4 mg/dl, post-transplant creatinine at day 100 2.1mg/dl. One patient (pre SCT serum creatinine 4.9mg/dl) required hemodialysis throughout the transplant period. Table 1 compares the patient characteristics and clinical outcomes in patients with and without renal insufficiency. PFS and OS rates of patients with renal insufficiency at the time of SCT were similar to those with normal renal function. There was no significant difference in transplant related toxicity between two groups. In conclusion, the outcomes of myeloma patients with renal insufficiency who underwent autologous SCT were not significantly different from those who had normal renal function at the time of transplant. Moreover, we observed a measurable improvement in the renal function after autologous SCT.

Table 1. Stratification of patient characteristics and clinical outcomes by renal insufficiency.

Serum creatinine ≥ 1.5mg/dl Serum creatinine &lt; 1.5mg/dl p value * Follow-up available in all but 1 patient. † Follow-up available in 59 (83%) patients. ‡ Follow-up available in 65 (92%) patients. Patients, no. 10 (12 %) 70 (88 %) Age (mean, years) 60 56 NS Male (%) 50 50 NS Patients receiving transplant ≤ 12months 8 (80%) 53 (76%) NS &gt; 12months 2 (20%) 17 (24%) NS ISS stage (%) 1 10 43 2 0 34 &lt; 0.01 3 90 23 B2microglobulin (mean, μg/ml) 15.26 3.24 &lt; 0.01 Patients receiving melphalan 200 mg/m2 5 (50%) 69 (98%) &lt; 0.01 ≤140 mg/m2 5 (50%) 1 (2%) PFS (median, months) 28* 25† NS OS (median, months) 53* 51‡ NS