Results of autologous stem cell transplant in multiple myeloma patients with renal failure

Data are presented on 81 multiple myeloma. (MM) patients with renal failure (creatinine > 176.8 mu mol/l) at the time of autologous stem cell transpla ntation (auto-SCT), including 38 patients on dialysis. The median age was 5 3 years (range: 29-69) and 26% had received more than 12 months of prior ch emotherapy. CD34(+) cells were mobilized with granulocyte colony-stimulatin g factor (G-CSF) alone (n = 51) or chemotherapy plus G-CSF (n = 27), yieldi ng medians of 10 and 16 x 10(6) CD34(+) cells/kg respectively (P = 0.003). Sixty patients (27 on dialysis) received melphalan 200 mg/m(2) (MEL-200). B ecause of excessive toxicity the subsequent 21 patients (11 on dialysis) re ceived AM, 140 mg/m(2) (MEL-140). Thirty-one patients (38%) completed tande m auto-SCT, including 11 on dialysis. Treatment-related mortality (TRM) was 6% and 13% after the first and second auto-SCT. Median times to absolute n entrophil count (ANC) > 0.5 x 10(9)/I and to platelets > 50 x 10(9)/I were 11 and 41 d respectively. Non-haematological toxicities included mucositis, pneumonitis, dysrhythmias and encephalopathy. At a median follow up of 31 months, 30 patients have died. Complete remission (CR) was achieved in 21 p atients (26%) after first SCT and 31 patients (38%) after tandem SCT. Two p atients discontinued dialysis after SCT. Median durations of complete remis sion (CR) and overall survival (OS) have not been reached; probabilities of event-free survival (EFS) and OS at 3 years were 48% and 55% respectively. Dialysis dependence and MEL dose did not affect EFS or OS. Sensitive disea se prior to SCT, normal albumin level and younger age were independent prog nostic factors for, better OS. In conclusion, renal failure had no impact o n the quality of stem cell collections and did not affect engraftment. MEL- 140 had an acceptable toxicity and appeared equally effective as MEL-200. I n the setting of renal failure, the role of auto-SCT early in the disease c ourse and benefits of tandem SCT require further evaluation.