The implication of compromised renal function at presentation in myeloma -Similar outcome in Patients who receive high-dose therapy: A single-centerstudy of 251 previously untreated patients

The purpose of the study was to determine the role of sequential therapy (S T) in new patients with myeloma presenting with renal dysfunction (RD): ser um creatinine >140 mu mol/L (1.6 mg/dL). Between April 1985 and June 1998, 251 patients, 59 (23%) with RD were entered into a ST program comprised of infusional chemotherapy (IC) with VAMP/C-VAMP (vincristine, doxorubicin, an d methylprednisolone with/without cyclophosphamide) followed by autologous transplantation and interferon maintenance. The median overall survival (OS) of 251 patients from the start of IC was 4 .2 yr with the RD group faring significantly poorer (median 2.5 yr) than th ose with no renal dysfunction (NRD; median 4.6 yr; p=0.0025). Mortality dur ing the first 100 d of IC was significantly higher in patients with RD (11/ 59; p=0.01) compared to patients with NRD. In patients consolidated with hi gh-dose therapy, the OS and event-free survival (EFS) were not significantl y different between the two groups. Cox analysis of the variables at presen tation failed to show RD as a factor influencing outcome, but it showed tha t patients with beta-2-microglobulin (beta M-2) greater than or equal to3.7 (p<0.0001), age <greater than or equal to> yr (p=0.002), performance statu s (PS) greater than or equal to2 (p=0.005) and patients with light-chain my eloma (p=0.03) had a significantly shorter OS, beta M-2 greater than or equ al to 3.7, PS greater than or equal to 2, and light-chain myeloma were pred ictive of shorter EFS. The study shows that with modern intensive schedules of treatment, renal di sease at presentation in isolation does not compromise outcome.