B3(Th)
FACTORS THAT DETERMINE SURVIVAL IN PATIENTS WITH MULTIPLE
MYELOMA WHO RECEIVE DIALYSIS
Roberts, R1, Stratton, J2, Summers, D3, Sivalingam, M1, Farrington, K1
1
East and North Hertfordshire NHS Trust, Stevenage, 2Royal Cornwall Hospitals NHS
Trust, Truro, 3University of Cambridge Department of Surgery
INTRODUCTION: Registry data indicate that patients with end stage renal failure and
multiple myeloma have a median survival of approximately 11 months1. However, some
patients exceed survival expectations and may live several years. Early recognition of factors
that are associated with better prognosis would inform clinical decisions and enhance care.
The aim of this study was to investigate factors that predict survival advantage in patients
with multiple myeloma who require dialysis.
METHODS: The case notes of 94 patients who presented between January 1st 1991 and 30th
June 2009 with myeloma (diagnosed according to International Myeloma Working Group
criteria) who received dialysis were reviewed. The influence on survival of: presentation
blood parameters (haemoglobin, white cell count, platelet count, corrected calcium, creatinine
and albumin); patient age (median, 68, range 37-88) and gender (53:41 M:F ratio); disease
burden (paraprotein type, titre, bence jones protein titre, percentage of plasma cells on bone
marrow biopsy); era of diagnosis (before or after 2000); Karnofsky performance score (KPS)
on admission; comorbidities (cardiovascular, neurological, respiratory disease, diabetes and
other malignancies); treatment (plasma exchange, bone marrow transplantation) and renal
recovery was assessed with a step-wise approach using Cox proportional hazards model.
RESULTS: On performing adjusted analysis only renal recovery and KPS were independent
predictors of improved survival. Patients who recovered their renal function had a 94.7% 12
month survival compared to 26.7% one year survival for those who did not (hazard ratio of
4.38(95% confidence intervals 2.32-8.26) for death in patients with no renal recovery).
Patients with a KPS of >=70% had a 55.6% 12 month survival compared to 18.9% for KPS <
70% (adjusted hazard ratio for death of 2.99(1.64-5.47) for patients with admission KPS of
<=50%). Surprisingly disease burden was not associated with survival, although, due to the
retrospective nature of the study, data is incomplete
CONCLUSION: Reversal of renal failure and greater functional performance offer survival
advantage to patients with multiple myeloma who require dialysis. The impact of renal
recovery is considerable. Our analysis does not identify whether this renal recovery reflects a
cohort of patients with inherently advantageous disease properties or whether renal recovery
is modifiable by alterations in management. If the latter, then strategies aimed at improving
renal function, such as more aggressive chemotherapy regimens or specialised dialysis to
remove nephrotoxic immunoglobulin, may improve survival.
REFERENCE:
1. Tsakiris, D, Stel, V, Finne, P, Fraser, E, Heat, J, de Meester, J, Schmaldienst,S,
Dekker, F, Verrina, E, Jager, K. Incidence and outcome of patients starting renal
replacement therapy for end stage renal failure due to multiple myeloma or light
chain deposit disease: an ERA-EDTA Registry Study. NDT (2010) 25: 1200-1206