Outcomes of therapeutic plasma exchange for the treatment of patients with multiple myeloma cast nephropathy

IF 3.3 4区医学 Q2 HEMATOLOGY

Hematological Oncology Pub Date : 2024-06-14 DOI:10.1002/hon.3293

Danai Dima, Utkarsh Goel, Aishwarya Sannareddy, Nnaemeka Ibeh, Fauzia Ullah, Aimaz Afrough, Sandra Mazzoni, Ali Mehdi, Joslyn Rudoni, Shahzad Raza, Nicole De Simone, Louis Williams, Adeel Khan, Aliya Rashid, Mikhaila Rice, Kristin Ricci, Christy Samaras, Jason Valent, Larry D. Anderson, Faiz Anwer, Gurbakhash Kaur, Jack Khouri

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Abstract

Current treatment guidelines of myeloma cast nephropathy (MCN) recommend the institution of plasma cell-directed therapy and consideration of therapeutic plasma exchange (TPE), with the goal of rapid reduction of the serum free light chain (sFLC). However, the role of TPE continues to remain a subject of debate. The goal of this retrospective bi-institutional study was to evaluate the clinical outcomes of TPE in combination with systemic therapy. Eighty patients were included in this analysis, of whom 72.5% had ≥50% drop in their initial involved sFLC. At 3 months from TPE initiation, the overall hematologic response rate (ORR) was 67.5% with a very good partial response or better (≥VGPR) rate of 40%. At 6 months, ORR was 57.5%, with ≥VGPR rate of 49%. The renal response rate at 3 and 6 months was 47.5% and 43.75%, respectively; the overall renal response rate was 48.75%. On multivariable analysis, every one unit increase in baseline creatinine (odds ratio [OR] 0.76, p = 0.006), and achievement of ≥VGPR (OR 21.7 p < 0.0001) were significantly associated with renal response. Also, a ≥50% drop in sFLC was favorably associated with renal response (OR 3.39, p = 0.09). With a median follow-up of 36.4 months, the median overall survival (OS) was 11 months. On multivariable analysis, achievement of renal response (hazard ratio [HR] 0.3, p < 0.0001) and newly diagnosed disease (NDMM; HR 0.43, p = 0.0055) were associated with improved OS. Among NDMM patients, those treated with daratumumab-based regimens had a trend for better OS (p = 0.15), compared to other regimens, but the difference was not significant. At the end of follow-up, an estimated 40.4% of patients who were on dialysis were able to become dialysis independent. In conclusion, our study highlights the poor survival of patients with MCN. Achievement of early renal response is crucial for prolonged OS, with daratumumab-based therapies showing promise.

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治疗性血浆置换治疗多发性骨髓瘤铸型肾病患者的疗效。

骨髓瘤铸型肾病（MCN）的现行治疗指南建议采用血浆细胞导向疗法并考虑治疗性血浆置换（TPE），目的是快速降低血清游离轻链（sFLC）。然而，TPE 的作用仍存在争议。这项双机构回顾性研究旨在评估 TPE 与全身治疗相结合的临床效果。这项分析共纳入了 80 名患者，其中 72.5% 的患者初始 sFLC 下降了≥50%。开始 TPE 治疗 3 个月后，总体血液学反应率（ORR）为 67.5%，部分反应非常好或更好（≥VGPR）的比例为 40%。6个月时，ORR为57.5%，≥VGPR率为49%。3个月和6个月时的肾脏反应率分别为47.5%和43.75%；总体肾脏反应率为48.75%。经多变量分析，基线肌酐每增加一个单位（几率比 [OR] 0.76，P = 0.006），达到≥VGPR（OR 21.7，P = 0.006）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Hematological Oncology 医学-血液学

CiteScore

4.20

自引率

6.10%

发文量

147

审稿时长

>12 weeks

期刊介绍： Hematological Oncology considers for publication articles dealing with experimental and clinical aspects of neoplastic diseases of the hemopoietic and lymphoid systems and relevant related matters. Translational studies applying basic science to clinical issues are particularly welcomed. Manuscripts dealing with the following areas are encouraged: -Clinical practice and management of hematological neoplasia, including: acute and chronic leukemias, malignant lymphomas, myeloproliferative disorders -Diagnostic investigations, including imaging and laboratory assays -Epidemiology, pathology and pathobiology of hematological neoplasia of hematological diseases -Therapeutic issues including Phase 1, 2 or 3 trials as well as allogeneic and autologous stem cell transplantation studies -Aspects of the cell biology, molecular biology, molecular genetics and cytogenetics of normal or diseased hematopoeisis and lymphopoiesis, including stem cells and cytokines and other regulatory systems. Concise, topical review material is welcomed, especially if it makes new concepts and ideas accessible to a wider community. Proposals for review material may be discussed with the Editor-in-Chief. Collections of case material and case reports will be considered only if they have broader scientific or clinical relevance.