The following is a summary of “Impact of Renal Impairment in Multiple Myeloma Patients Undergoing Autologous Stem Cell Transplantation With Melphalan Conditioning,” published in the October 2023 issue of Hematology by Ursu et al.

Multiple myeloma (MM) patients undergoing autologous stem cell transplantation (ASCT) lack standardized renal dose adjustments for melphalan conditioning.

Researchers started a retrospective study to evaluate the impact of melphalan dosing and chronic kidney disease (CKD) on transplant-related outcomes, progression-free survival (PFS), and overall survival (OS) in multiple myeloma patients undergoing ASCT.

They encompassed MM patients who had undergone ASCT. Patients received either Melphalan at 200 mg/m² (Mel200) or 140 mg/m² (Mel140). The patient group was categorized based on renal function: those with creatinine clearance (CrCl). 60 mL/min (no-CKD) and those with CrCl < 60 mL/min (CKD). Recorded outcomes comprised PFS, OS, treatment-related mortality (TRM), incidence of adverse events, hospital stay duration, and readmission within 30 days. Statistical analysis included Chi-square tests, t-tests, and the Kaplan-Meier method, with a logistic regression model used to adjust for melphalan dosage.

The results showed 124 patients, 108 in the no-CKD group and 16 in the CKD group. The median age was 62, mostly male (62%), with 97% achieving at least a partial response during ASCT. Of 124 patients, 9 (7%) received Mel140, 5 had CKD (CrCl range: 26 – 58 mL/min), and 1 was on hemodialysis. The CKD group had neutrophil engraftment at 13.6 days, the no-CKD group at 14.9 days, and platelet engraftment at 18.3 days for CKD and 18.5 days for no-CKD.These differences were statistically significant (P=0.03 and P=0.8). Post melphalan dose adjustment, the median time to neutrophil engraftment showed no statistical significance (P=0.11). At a median follow-up of 28.7 months, the median PFS for the CKD group was 60 months, while the no-CKD group was 46 months (P=0.3). The one-year OS was 93.8% in the CKD group and 97% in the no-CKD group. The CKD group exhibited a higher incidence of grade 3 or 4 mucositis than the no-CKD group (P=0.013).

They concluded that melphalan conditioning for ASCT in MM patients with CKD does not significantly affect engraftment, PFS, or OS, but severe mucositis is more common.

Source: thejh.org/index.php/jh/article/view/1148