Abstract 587: Improvement in renal function in patients with multiple myeloma and impaired renal function receiving novel agent induction therapies
Authors: Li Liang , Hu Shuai , Zhu Hao , Wang Yaning , Ma Lian , Booth Brian P. , Rahman Nam Atiqur , Schwartz Janice , Blumenthal Gideon , Liu Qi 
Published: September 2020

BACKGROUND: Renal impairment (RI) is a common complication in patients with multiple myeloma (MM). Effective myeloma treatment can lead to reduction in urinary light-chain excretion and reversibility of RI. Our pooled analysis assessed the magnitude of improvement in renal function (RF) in patients with newly diagnosed (ND) or relapsed and/or refractory (RR) MM treated with novel agent induction therapies, including 3 immunomodulators, 3 proteasome inhibitors, 1 histone deacetylase inhibitor, 1 XP01 inhibitor and 2 monoclonal antibodies.

METHODS: Seventeen registrational trials with 34 treatment arms that collected time profiles of RF during treatment with novel agent induction therapies in 3569 patients with NDMM and 7786 patients with RRMM at baseline were identified from various new drug applications submitted to the US FDA. Change in estimated glomerular filtration rate (eGFR, as estimated by Modification of Diet in Renal Disease formula) compared to baseline was summarized for each therapy.

RESULTS: Increase in eGFR was observed in patients with MM and each category of RI (mild [eGFR 60 - &lt;90 mL/min/1.73 m2], moderate [eGFR 30 - &lt;60 mL/min/1.73 m2] or severe [eGFR 15 - &lt;30 mL/min/1.73 m2]) at baseline who received induction therapies. The time to greatest improvement in eGFR was approximately 3 to 6 months post-treatment. The average improvement in eGFR between Month 3 and 6 post-treatment, as compared to baseline, is summarized in Table 1 for each therapy. Further analysis showed that patients with clinical objective responses (partial response or better) tended to have greater improvement in eGFR than non-responders, especially in patients with NDMM.

Table 1:Improvement in eGFR in patients with MM and RI during the treatment of novel agent induction therapies between Month 3 and 6 as compared to baseline.PatientsTherapyMean (SD) increase in eGFR (mL/min/1.73 m2)% of patients with improvement in eGFR by at least 1 categoryRRMM (N=7786)Monotherapy A8.8 (15.3)33%Monotherapy B-1.5 (10.4)10%Monotherapy C5.9 (13.9)25%Combination D7.7 (15.4)30%Combination E8.9 (17.2)30%Combination F8.1 (14.9)33%Combination G7.6 (14.6)28%Combination H9.5 (16.1)34%Combination I6.5 (14.0)28%Combination J7.4 (14.6)27%Combination K7.6 (14.8)28%Combination L6.4 (12.0)17%Combination M3.1 (14.5)13%Combination N11.2 (17.1)38%NDMM (N-3569)Combination D7.8 (16.4)32%Combination J7.6 (16.0)29%Combination O6.0 (15.2)28%Combination P10.1 (16.7)38%Combination Q10.4 (17.5)37%Combination R11.5 (17.7)38%

CONCLUSIONS: During the treatment with novel agent induction therapies for MM, frequent assessment of RF is needed in patients with RI to guide the proper dosing regimen.

Citation Format: Liang Li, Shuai Hu, Hao Zhu, Yaning Wang, Lian Ma, Brian P. Booth, Nam Atiqur Rahman, Janice Schwartz, Gideon Blumenthal, Qi Liu. Improvement in renal function in patients with multiple myeloma and impaired renal function receiving novel agent induction therapies [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 587.