![]() Of note, improved outcomes were seen in patients with moderate CKD receiving high dose melphalan at 200 mg/m 2. , which showed that ASCT is safe in patients with moderate and severe CKD. Further supporting evidence was provided by a study from Mahindra et al. On the other hand, several studies have suggested that ASCT significantly improves the life expectancy and disease outcomes in MM patients with RI. This, in addition to high dose melphalan-associated toxicities, resulting in higher morbidity and transplant-related mortality (TRM), has led some physicians to preclude patients with advanced CKD from transplant consideration. identified CKD as an independent risk factor for AKI after ASCT for MM, with a significantly higher mortality rate in this subgroup of patients. However, its use in patients with CKD has been controversial, due to the perceived risk of renal deterioration secondary to transplant-related toxicity in patients with pre-existing renal impairment. ĪSCT is a well-established consolidation strategy for patients with MM who have achieved remission with induction or salvage treatment. The introduction of novel agents, such as bortezomib, lenalidomide and thalidomide, has been shown not only to be safe in CKD, but also to be associated with a more rapid improvement in renal function and improved progression-free survival (PFS) and overall survival (OS) rates. Įarly initiation of anti-myeloma treatment has been shown to have a positive impact on renal function, with a number of studies suggesting that 70% of patients may achieve normalisation of their renal function, resulting in prolonged survival rates. Renal impairment (RI) is associated with high mortality rates, reaching up to 30% in the first two months post diagnosis of MM, as well as increased morbidity resulting in increased healthcare costs and inferior outcomes. Approximately 10% of MM patients have advanced CKD requiring long-term dialysis. Patients who demonstrate renal deterioration at 1-year post-transplant should be closely monitored as this is a predictor for poor survival.Ĭhronic kidney disease (CKD) and acute kidney injury (AKI) are major complications of multiple myeloma (MM), affecting a third of patients at presentation and nearly 50% at some point during the course of the disease. The results of this study show that ASCT is a safe and effective option for myeloma patients with CKD, including those on dialysis. ![]() ![]() A decline in estimated glomerular filtration rate (eGFR) at 1-year of >8.79% was associated with poorer overall survival ( p < 0.001). No significant difference in ASCT-related mortality, Progression-Free or Overall Survival was noted between the different renal function groups. To investigate this, we conducted a retrospective analysis of 370 MM patients who underwent their first ASCT, including those with mild, moderate and severe CKD as well as normal renal function at the time of transplant. ![]() The use of autologous stem cell transplantation (ASCT) has improved disease outcomes, however, the safety and efficacy of ASCT in patients with CKD has been the subject of debate. Chronic Kidney Disease (CKD) is a frequent complication in patients with multiple myeloma (MM) and is associated with adverse outcomes.
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