1. The role of novel agents on the reversibility of renal impairment in newly diagnosed symptomatic patients with multiple myeloma.
- Author
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Dimopoulos MA, Roussou M, Gkotzamanidou M, Nikitas N, Psimenou E, Mparmparoussi D, Matsouka C, Spyropoulou-Vlachou M, Terpos E, and Kastritis E
- Subjects
- Adult, Aged, Aged, 80 and over, Boronic Acids administration & dosage, Bortezomib, Dexamethasone administration & dosage, Doxorubicin administration & dosage, Female, Follow-Up Studies, Glomerular Filtration Rate, Humans, Lenalidomide, Male, Melphalan administration & dosage, Middle Aged, Multiple Myeloma complications, Multiple Myeloma diagnosis, Prednisone administration & dosage, Prognosis, Pyrazines administration & dosage, Renal Insufficiency etiology, Survival Rate, Thalidomide administration & dosage, Thalidomide analogs & derivatives, Vincristine administration & dosage, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Multiple Myeloma drug therapy, Renal Insufficiency drug therapy
- Abstract
The role of thalidomide, bortezomib and lenalidomide in multiple myeloma patients presenting with renal impairment was evaluated in 133 consecutive newly diagnosed patients who were treated with a novel agent-based regimen. A significant improvement of renal function (renalPR (renal partial response)) was observed in 77% of patients treated with bortezomib, in 55% with thalidomide and in 43% with lenalidomide (P=0.011). In multivariate analysis, bortezomib-based therapy was independently associated with a higher probability of renal response compared with thalidomide- or lenalidomide-based therapy. Other important variables included eGFR (estimated glomerular filtration rate) ≥30 ml/min, age ≤65 years and myeloma response. Patients treated with bortezomib achieved at least renalPR in a median of 1.34 months vs 2.7 months for thalidomide and >6 months for lenalidomide-treated patients (P=0.028). In multivariate analysis bortezomib-based therapy, higher doses of dexamethasone (≥160 mg during the first month of treatment), an eGFR ≥30 ml/min and age ≤65 years were independently associated with shorter time to renal response. In conclusion, bortezomib-based therapies may be more appropriate for the initial management of patients with myeloma-related renal failure; however, thalidomide and lenalidomide are also associated with significant probability of improvement of their renal function.
- Published
- 2013
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