Autologous HSCT outcomes in patients with MM and renal insufficiency

Garderet L, Ouldjeriouat H, Bekadja M-A, et al. Low Non-Relapse Mortality and Good Haematological and Renal Responses After Autologous Haematopoietic Stem Cell Transplantation in Multiple Myeloma Patients With Renal Insufficiency at Transplant: A Prospective Société Francophone de Greffe de Moelle-Thérapie Cellulaire Observational Study. British Journal of Haematology. 2023; (doi: 10.1111/bjh.19163).

The safety and efficacy of autologous hematopoietic stem cell transplantation (ASCT) has been called into question for multiple myeloma (MM) patients with renal dysfunction, but new findings support the standard of care in this patient subset. A prospective cohort study included 50 adults with newly diagnosed MM who had a serum creatinine clearance of <40mL/min at the time of their transplant performed between April 2018 and October 2020. Patients received high dose of melphalan at the recommended dose of 140 mg/m2. The cumulative incidence of non-relapse mortality at 100 days post-procedure — the primary outcome — was 2%, rising to 6% by the 1-year mark. One study participant died within the first 100 days after ASCT, and neutrophil and platelet engraftment was not disrupted in any patient. Overall survival and progression-free survival reached 84% and 70%, respectively, at 2-year followup, while the cumulative incidence of relapse was 20%. Hematological response improved in 69% of participants, while renal response improved in 59% of them. The data confirmed that autologous transplantation delivers sound results without excessive deaths in MM patients who present with renal insufficiency at the time of ASCT, making it both a safe and effective treatment for this patient population.

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Tags: multiple myeloma, response, hematology, hematopoietic, Mortality, post-transplant, Autologous, improved, MM, hematopoietic stem cell transplantation