دورية أكاديمية
Outcomes of therapeutic plasma exchange for the treatment of patients with multiple myeloma cast nephropathy.
| العنوان: | Outcomes of therapeutic plasma exchange for the treatment of patients with multiple myeloma cast nephropathy. |
|---|---|
| المؤلفون: | Dima D; Multiple Myeloma Program, Department of Hematology and Medical Oncology, Cleveland Clinic, Taussig Cancer Institute, Cleveland, Ohio, USA.; University of Washington, Fred Hutchinson Cancer Center, Seattle, Washington, USA., Goel U; Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA., Sannareddy A; Myeloma, Waldenstrom's, and Amyloidosis Program, Hematologic Malignancies and Cellular Therapy Program, Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas, USA., Ibeh N; Department of Pathology and Laboratory Medicine, University of Texas, Houston, Texas, USA., Ullah F; Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA., Afrough A; Myeloma, Waldenstrom's, and Amyloidosis Program, Hematologic Malignancies and Cellular Therapy Program, Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas, USA., Mazzoni S; Multiple Myeloma Program, Department of Hematology and Medical Oncology, Cleveland Clinic, Taussig Cancer Institute, Cleveland, Ohio, USA., Mehdi A; Department of Nephrology and Hypertension, Cleveland Clinic, Cleveland, Ohio, USA., Rudoni J; Multiple Myeloma Program, Department of Hematology and Medical Oncology, Cleveland Clinic, Taussig Cancer Institute, Cleveland, Ohio, USA., Raza S; Multiple Myeloma Program, Department of Hematology and Medical Oncology, Cleveland Clinic, Taussig Cancer Institute, Cleveland, Ohio, USA., De Simone N; Myeloma, Waldenstrom's, and Amyloidosis Program, Hematologic Malignancies and Cellular Therapy Program, Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas, USA., Williams L; Multiple Myeloma Program, Department of Hematology and Medical Oncology, Cleveland Clinic, Taussig Cancer Institute, Cleveland, Ohio, USA., Khan A; Myeloma, Waldenstrom's, and Amyloidosis Program, Hematologic Malignancies and Cellular Therapy Program, Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas, USA., Rashid A; Department of Internal Medicine, University of Kansas, Kansas City, Kansas, USA., Rice M; Multiple Myeloma Program, Department of Hematology and Medical Oncology, Cleveland Clinic, Taussig Cancer Institute, Cleveland, Ohio, USA., Ricci K; Multiple Myeloma Program, Department of Hematology and Medical Oncology, Cleveland Clinic, Taussig Cancer Institute, Cleveland, Ohio, USA., Samaras C; Multiple Myeloma Program, Department of Hematology and Medical Oncology, Cleveland Clinic, Taussig Cancer Institute, Cleveland, Ohio, USA., Valent J; Multiple Myeloma Program, Department of Hematology and Medical Oncology, Cleveland Clinic, Taussig Cancer Institute, Cleveland, Ohio, USA., Anderson LD Jr; Myeloma, Waldenstrom's, and Amyloidosis Program, Hematologic Malignancies and Cellular Therapy Program, Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas, USA., Anwer F; Multiple Myeloma Program, Department of Hematology and Medical Oncology, Cleveland Clinic, Taussig Cancer Institute, Cleveland, Ohio, USA., Kaur G; Myeloma, Waldenstrom's, and Amyloidosis Program, Hematologic Malignancies and Cellular Therapy Program, Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas, USA., Khouri J; Multiple Myeloma Program, Department of Hematology and Medical Oncology, Cleveland Clinic, Taussig Cancer Institute, Cleveland, Ohio, USA. |
| المصدر: | Hematological oncology [Hematol Oncol] 2024 Jul; Vol. 42 (4), pp. e3293. |
| نوع المنشور: | Journal Article; Multicenter Study |
| اللغة: | English |
| بيانات الدورية: | Publisher: Wiley-Blackwell Country of Publication: England NLM ID: 8307268 Publication Model: Print Cited Medium: Internet ISSN: 1099-1069 (Electronic) Linking ISSN: 02780232 NLM ISO Abbreviation: Hematol Oncol Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: Oxford, England : Wiley-Blackwell, c1983- |
| مواضيع طبية MeSH: | Multiple Myeloma*/therapy , Multiple Myeloma*/mortality , Plasma Exchange*/methods, Humans ; Male ; Female ; Middle Aged ; Aged ; Retrospective Studies ; Treatment Outcome ; Adult ; Aged, 80 and over ; Kidney Diseases/therapy ; Kidney Diseases/etiology |
| مستخلص: | Current treatment guidelines of myeloma cast nephropathy (MCN) recommend the institution of plasma cell-directed therapy and consideration of therapeutic plasma exchange (TPE), with the goal of rapid reduction of the serum free light chain (sFLC). However, the role of TPE continues to remain a subject of debate. The goal of this retrospective bi-institutional study was to evaluate the clinical outcomes of TPE in combination with systemic therapy. Eighty patients were included in this analysis, of whom 72.5% had ≥50% drop in their initial involved sFLC. At 3 months from TPE initiation, the overall hematologic response rate (ORR) was 67.5% with a very good partial response or better (≥VGPR) rate of 40%. At 6 months, ORR was 57.5%, with ≥VGPR rate of 49%. The renal response rate at 3 and 6 months was 47.5% and 43.75%, respectively; the overall renal response rate was 48.75%. On multivariable analysis, every one unit increase in baseline creatinine (odds ratio [OR] 0.76, p = 0.006), and achievement of ≥VGPR (OR 21.7 p < 0.0001) were significantly associated with renal response. Also, a ≥50% drop in sFLC was favorably associated with renal response (OR 3.39, p = 0.09). With a median follow-up of 36.4 months, the median overall survival (OS) was 11 months. On multivariable analysis, achievement of renal response (hazard ratio [HR] 0.3, p < 0.0001) and newly diagnosed disease (NDMM; HR 0.43, p = 0.0055) were associated with improved OS. Among NDMM patients, those treated with daratumumab-based regimens had a trend for better OS (p = 0.15), compared to other regimens, but the difference was not significant. At the end of follow-up, an estimated 40.4% of patients who were on dialysis were able to become dialysis independent. In conclusion, our study highlights the poor survival of patients with MCN. Achievement of early renal response is crucial for prolonged OS, with daratumumab-based therapies showing promise. (© 2024 The Author(s). Hematological Oncology published by John Wiley & Sons Ltd.) |
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| فهرسة مساهمة: | Keywords: cast nephropathy; daratumumab; multiple myeloma; plasmapheresis; therapeutic plasma exchange |
| تواريخ الأحداث: | Date Created: 20240614 Date Completed: 20240614 Latest Revision: 20240729 |
| رمز التحديث: | 20240729 |
| DOI: | 10.1002/hon.3293 |
| PMID: | 38872511 |
| قاعدة البيانات: | MEDLINE |
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