Evaluation of Multiple Myeloma Patients Presenting with Renal Failure in a University Hospital in the Year 2010

Figures & data

Table 1. Patient characteristics.

	Patients without renal failure, n (%)	Patients with renal failure, n (%)
	n = 22	n = 8	p-Value
Age (years), median (range)	63 (37–80)	62 (41–79)	0.801
Sex (F/M) (n)	14/8	3/5	0.298
Creatinine (mg/dL), median (range)	0.94 (0.52–1.72)	4.9 (2.02–12.9)	0.00
Creatinine clearance (mL/min), median (range)	71 (30–124)	11 (3–32)	0.00
<15	–	5 (62.5)
15–29	–	1 (12.5)
30–59	9 (40.9)	2 (25)
60–89	10 (45.5)	–
≥90	3 (13.6)	–
Calcium (mg/dL) median (range)	9.45 (8.5–16.8)	12.3 (8.3–15.1)	0.78
≥11.5 mg/dL	2 (9.1)	5 (62.5)
<11.5 mg/dL	20 (90.9)	3 (37.5)
Hemoglobin (g/dL), median (range)	11 (6–16.6)	8.35 (7.26–10.5)	0.024
≥10.5 g/dL	14 (63.6)	1 (12.5)
<10.5 g/dL	8 (36.4)	7 (87.5)
Albumin (mg/dL), median (range)	3.4 (2.3–4.3)	3.4 (1.6–4.2)	0.662
Median β-2 microglobulin (mg/dL) (range)	4.9 (1.96–11.4)	16 (0.12–17.6)	0.055
ISS (data available in 23/29)			0.036
Stage I	4 (23.5)	–
Stage II	6 (35.3)	–
Stage III	7 (41.2)	6 (100)
Myeloma subtype			0.597
IgG-kappa	11 (50)	4 (50)
IgG-lambda	5 (22.7)	1 (12.5)
IgA-kappa	1 (4.5)	–
IgA-lambda	3 (13.6)	–
IgM-lambda	1 (4.5)	–
Free kappa	1 (4.5)	3 (37.5)
Kappa/lambda (data available in 27/29 patients)			0.237
Normal	6 (30)	–
Abnormal	14 (70)	8 (100)
Bone marrow plasma cell ratio			0.447
>40	15 (68.2)	7 (87.5)
≤40	7 (31.8)	1 (12.5)

Note: The bold p-Values indicate that 0.00 should be <0.001.

Table 2. Clinical and laboratory features of the patients with renal failure.

	Age/sex	Myeloma type	Stage: Durie–Salmon/ISS	fκ/fλ	Cr (mg/dL)	CrCl (mL/min)	Proteinuria (mg/24 h)	Ca (mg/dL)	LDH (U/dL)	Hb (g/dL)	Alb (g/dL)	Amyloidosis	Symptoms	DOS	Department of first admission
Patient 1	59/M	IgG-kappa	IIIB/III	408	2.17	27	1254	14.3	194	7.7	2.2	Negative	Back pain, weight loss, polydipsia	2 months	Hematology
Patient 2	65/M	IgG-lambda	IIIB/III	0.0014	6.38	10	3820	12.7	281	7.9	4.2	Negative	Back pain	3 months	Nephrology
Patient 3	76/M	IgG-kappa	IIIB/III	445	2.02	33	1185	12	161	10	3.4	Negative	Back pain	4 months	Nephrology
Patient 4	55/M	IgG-kappa	IIIB/III	170	3.99	12	1054	14.5	120	8	1.6	Negative	Back pain	3 years	Internal medicine
Patient 5	72/F	Kappa	IIIB/III	192	3.74	12	2584	8.9	231	9.6	3.3	Negative	Gastroenteritis	2 days	Nephrology
Patient 6	41/F	IgG-kappa	IIIB/?	1231	12.9	4	2608	10.5	205	8.7	3.8	Negative	Gastroenteritis	1 week	Nephrology
Patient 7	56/M	Kappa	IIIB/III	1660	5.81	14	5516	15.1	174	10.5	3.5	Negative	Back pain	2 months	Nephrology
Patient 8	79/F	Kappa	IIIB/?	978	6.92	7	3261	8.34	217	7.26	3.1	Negative	Nausea, vomiting	1 months	Nephrology

Notes: Alb, albumin; Ca, calcium; Cr, creatinine; CrCl, creatinine clearance; DOS, duration of symptoms; fκ/fλ, free kappa/free lamda; Hb, hemoglobin; ISS, international staging system, LDH, lactate dehydrogenase.

Table 3. Treatment data and the outcome of the patients with renal failure.

Patients	Treatment	Dialysis	Cr at admission (mg/dL)	Cr after treatment (mg/dL)	CrCl at admission (mL/min)	CrCl after treatment (mL/min)	Time from admission to the start of treatment	Disease response	Duration of disease response (months)	Outcome
1	VD	Yes	2.17	7.16	32	8	7 days	NA	NA	Died/on dialysis
2	VCD	No	6.38	1.29	9	56	21 days	CR	12	Alive/not on dialysis
3	V-mel	No	2.02	0.96	32	76	18 days	CR	15	Alive/not on dialysis
4	VCD	No	3.99	0.72	16	113	12 days	CR	15	Alive/not on dialysis
5	VCD	No	3.74	2.62	12	18	12 days	PR	6	Alive/not on dialysis
6	VCD	Yes	12.9	1.33	3	46	24 days	PR	5	Alive/not on dialysis
7	VCD	Yes	5.81	5.3	10	9	3 days	NR	NR	Alive/on dialysis
8	VD	Yes	6.92	?	7	?	17	NA	NA	Lost to follow-up/on dialysis

Notes: Cr, creatinine; CrCl, creatinine clearance; CR, complete remission; NA, not assessed; NR, no response; PR, partial remission; VD, bortezomib-dexamethasone; VCD, bortezomib-cyclophosphamide-dexamethasone; V-mel, bortezomib-melphalan.