A clinical analysis of 69 newly diagnosed multiple myeloma patients with renal insufficiency

Objective To investigate the efficacy and outcome in newly diagnosed multiple myeloma (MM) patients with renal insufficiency using bortezomib- or thalidomide-based regimens as front line treatment. Method Sixty-nine newly diagnosed MM patients with renal insufficiency were retrospectively analyzed from August 2006 to August 2014. Results ① Among thirty-nine patients with bortezomib based regimens (the bortezomib group), the overall response rate (ORR) was 89.7% and complete response (CR) plus near CR(nCR) rate was 41.0%. By contrast, among thirty patients with thalidomide based regimens (the thalidomide group), the ORR was 83.3% and CR+ nCR rate was 26.7%. There was no significant difference of either ORR or CR+ nCR rate between bortezomib and thalidomide groups. ② The improvement rate of renal function in bortezomib group and thalidomide group were 87.2% and 60.0% respectively (P=0.012). The median duration time of renal injury was 45 days in 52 patients with renal function improved, which was significantly shorter compared with 222 days in 17 patients without improvement (P<0.05). There was no difference of median serum creatinine and creatinine clearance rate between the two groups.③ The median progression-free survival (PFS) and the overall survival (OS) were 18 and 33.5 months, respectively in all patients. The three-year and five-year OS rates were 57% and 17%, respectively. The median PFS was 19 months in bortezomib group, while it was only 12 months in thalidomide group (P=0.023). The median OS were 36.5 months and 25.5 months respectively, which was no difference (P=0.285). Conclusions The newly diagnosed MM patients with renal insufficiency could get higher ORR and the longer PFS using bortezomib-containing regimens as initial therapy. Meanwhile the improvement rate of renal function and the living quality in patients with bortezomib are better compared with those with thalidomide based treatment. Key words: Multiple myeloma; Renal insufficiency; Improvement of renal function; Survival