Results of Autologous Hematopoietic Stem Cell Transplantation in Patients with Multiple Myeloma (MM) and Renal Impairment: A Retrospective Single-Center Study

Maiia Soloveva; Maxim Solovev; Daria Mironova; Larisa Mendeleeva

doi:10.18502/ijhoscr.v18i1.14745

Maiia Soloveva Department of High-Dose Chemotherapy of Paraproteinemic Hemoblastoses, FSFI «National Research Center for Hematology», Moscow, Russian Federation
Maxim Solovev Department of High-Dose Chemotherapy of Paraproteinemic Hemoblastoses, FSFI «National Research Center for Hematology», Moscow, Russian Federation
Daria Mironova Department of High-Dose Chemotherapy of Paraproteinemic Hemoblastoses, FSFI «National Research Center for Hematology», Moscow, Russian Federation
Larisa Mendeleeva Department of High-Dose Chemotherapy of Paraproteinemic Hemoblastoses, FSFI «National Research Center for Hematology», Moscow, Russian Federation

DOI: https://doi.org/10.18502/ijhoscr.v18i1.14745

Keywords: Multiple myeloma; Autologous Hematopoietic Stem Cell Transplantation (Auto-HSCT); Hemodialysis; Acute kidney injury; Cast nephropathy; Renal response

Abstract

Background: To assess the efficacy of autologous hematopoietic stem cell transplantation (auto-HSCT) in multiple myeloma (MM) patients with acute renal failure.

Materials and Methods: A retrospective single-center study included 64 patients (30 men, 34 women) with MM and kidney damage at the onset of the disease, aged 19 to 65 years (median 54), who underwent auto-HSCT from 2013 to 2019. 23 patients (36%) were dialysis-dependent at the time of diagnosis. The analysis was carried out in two groups: the "HD-" group (patients who were independent of hemodialysis during auto-HSCT, n = 54), and the "HD +" group (patients who underwent auto-HSCT while treated with programmed hemodialysis, n = 10). Research results were statistically processed using the Statistica software (version 10.0); the data obtained were presented graphically. Statistical analysis was performed using survival analysis (using the Kaplan-Meier method, with a Log-Rank Test) and frequency analysis (using contingency tables and Fisher's test).

Results: The patients dependent on hemodialysis were significantly more likely to require red blood cell transfusions compared to the dialysis-independent patients (100% versus 35%, p = 0.0001). Reactivation of a herpes viral infection and reversible toxic encephalopathy developed significantly more often in the patients from the “HD +” group compared with the patients from the “HD-” group (30% versus 6%, p = 0.04 and 20% versus 0%, p = 0.02, respectively). As a result of the treatment (induction + auto-HSCT), 14 patients (61%) became hemodialysis-independent. There was no transplant-related mortality. With a median follow-up of 48 months, the 5-year overall survival (OS) and progression-free survival (PFS) were 70% and 42%, respectively.

Conclusion: Auto-HSCT is a safe and effective treatment for patients with MM complicated by acute kidney injury. Fourteen of 23 (61%) patients became dialysis-independent.