Does Early Combination Therapy Impact Renal Response and Survival in Multiple Myeloma?
Posted: Wednesday, July 14, 2021
According to research presented as a letter published in the Blood Cancer Journal, the early use of combination therapy may induce renal response in patients with multiple myeloma and renal impairment. Joseph Mikhael, MD, of the City of Hope Cancer Center, Phoenix, and colleagues noted that this treatment approach may also result in overall improved outcomes for this patient population.
The study identified 10,389 patients who had been diagnosed with multiple myeloma between January 1, 2011, and November 20, 2019, and whose information was registered in the Flatiron Health database. Of those patients, 6,990 patients who had received at least one line of therapy, whose race was noted, and who did not have extreme creatinine levels were included. A total of 45.8% of patients were female, and 17.2% were Black.
At the onset of initial therapy, 1,722 patients had estimated glomerular filtration rate–Modification of Diet in Renal Disease (eGFR-MDRD) levels below 50 mL/min/1.73 m2, and 3,465 had levels at or above 50 mL/min/1.73 m2; the eGFR-MDRD levels for the remainder of patients were unknown. Those with levels below 50 mL/min/1.73 m2 at treatment onset were more likely to have had stage III disease at diagnosis and to be older than those with levels of at least 50 mL/min/1.73 m2 (37.7% vs. 10.3% and 71.3 vs. 67.3 years, respectively).
Patients who had eGFR-MDRD levels below 50 mL/min/1.73 m2 at the onset of first-line or second-line therapy experienced shorter median overall survival (first-line, 3.46 vs. 5.89 years; second-line, 2.67 vs. 4.44 years). The complete renal response was more likely among patients who had received combination therapies including proteasome inhibitors and immunomodulatory drugs during early treatment. For patients who received combination therapy and achieved a complete renal response, the median overall survival was longer.
“Future investigations with larger data sets that include newer agents may improve the understanding of the optimal combination treatment regimens for these patients,” concluded the authors.
Disclosure: For full disclosures of the study authors, visit nature.com.