Renal response and prognosis of newly diagnosed patients with multiple myeloma with renal impairment applying VRD and autologous hematopoietic stem cell transplantation
10.3760/cma.j.cn121090-20241211-00564
- VernacularTitle:肾功能受损的初诊多发性骨髓瘤患者应用VRD方案联合自体造血干细胞移植的肾脏反应及预后
- Author:
Xingyue WU
1
;
Yue HUANG
1
;
Hongmiao SHEN
1
;
Hongying YOU
1
;
Zhi YAN
1
;
Yan XIE
1
;
Weiqin YAO
1
;
Shuang YAN
1
;
Jing WANG
1
;
Yingying ZHAI
1
;
Xiaolan SHI
1
;
Jingjing SHANG
1
;
Song JIN
1
;
Lingzhi YAN
1
;
Depei WU
1
;
Chengcheng FU
1
Author Information
1. 苏州大学附属第一医院血液科，国家血液系统疾病临床医学研究中心，江苏省血液研究所，苏州 215000
- Publication Type:Journal Article
- Keywords:
Multiple myeloma;
Renal impairment;
Lenalidomide;
Autologous hematopoietic stem cell transplantation;
Renal response
- From:
Chinese Journal of Hematology
2025;46(9):839-847
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the feasibility of the bortezomib, lenalidomide, and dexamethasone (VRD) regimen combined with autologous hematopoietic stem cell transplantation (auto-HSCT) in patients with multiple myeloma (MM) and renal impairment, analyze treatment efficacy and renal responses stratified based on renal dysfunction severity, and explore the prognostic significance of early renal response and its affecting factors.Methods:This retrospective study, conducted at the First Affiliated Hospital of Soochow University, categorized 316 patients with newly diagnosed MM (NDMM) from August 2018 to October 2022 based on renal function for analysis of clinical characteristics, treatment response, and prognosis. Continuous variables were compared using t-tests or Mann-Whitney U tests, categorical variables utilizing Chi-square tests, survival outcomes employing Kaplan-Meier and Log-rank tests, and renal response predictors with logistic regression.Results:Patients were stratified based on baseline estimated glomerular filtration rate (eGFR) : normal [≥90 ml·min -1· (1.73 m 2) -1, n=160], mild [≥60 ml·min -1· (1.73 m 2) -1 to <90 ml·min -1· (1.73 m 2) -1, n=55], moderate [≥30 ml·min -1· (1.73 m 2) -1 to <60 ml·min -1· (1.73 m 2) -1, n=39], and severe impairment [<30 ml·min -1· (1.73 m 2) -1, n=62]. Moderate and severe renal impairment correlated with advanced International Staging System/Revised International Staging System classification, lower hemoglobin levels, frailty, and higher light-chain/IgD subtype prevalence ( P<0.05). Despite younger age ( P=0.001) and higher transplant rates ( P=0.041) in severe cases, overall response rates ( ORR: 93.7% ; ≥VGPR: 82.9% ) were comparable across groups ( P>0.05). Among 24 dialysis-dependent patients at diagnosis, 11 (45.8% ) achieved dialysis independence after induction [median: 3.0 (0.5–4.0) months], including 10 undergoing auto-HSCT. In 89 evaluable patients [baseline eGFR <50 ml·min -1· (1.73 m 2) -1], renal ORR (RORR) was 70.8% [rapid complete response: 31.5% ; rapid partial response: 11.2% ; rapid minimal response (RMR) : 28.1% ]. Renal response predicted better survival (overall survival: HR=0.36, 95% CI: 0.13–0.99, P=0.049). Moderate-to-severe renal impairment was associated with increased transplant-related adverse events and delayed engraftment ( P<0.05) ; however, auto-HSCT significantly improved outcomes after 33.5-month median follow-up (range: 2–65 months). Multivariate analysis identified 1q21+ ( OR=3.58, 95% CI: 1.17–11.02, P=0.026) and light-chain subtype ( OR=2.86, 95% CI: 1.08–7.69, P=0.036) as independent predictors of poor renal response. Conclusion:VRD regimen plus auto-HSCT demonstrates robust efficacy in NDMM, including patients with renal impairment, with a 70.8% RORR and manageable toxicity. Achieving ≥RMR correlates with superior prognosis, whereas 1q21+ and light-chain subtype independently predict inferior renal response.
