Renal outcome of patients with newly diagnosed multiple myeloma in a resource-limited setting

Abstract

Background: Effective anti-myeloma therapy is crucial for managing multiple myeloma (MM) with renal impairment. Due to limited resources and data on novel agent-free treatments, we evaluated renal outcomes among patients with newly diagnosed MM in a resource-limited setting. Objective: The study aimed to evaluate the effectiveness of frontline therapies in improving renal function among patients with newly diagnosed MM Method: We retrospectively reviewed renal responses in patients with newly diagnosed MM at Saraburi Hospital from 2013 to 2022, focusing on those who had undergone a minimum of 4 cycles of frontline therapy excluding those requiring hemodialysis. Results: A total of 64 patients with newly diagnosed MM were included in the study. Among these, 18 cases received steroid before chemotherapy, while 46 cases did not. Frontline treatment regimens were administered including cyclophosphamide-dexamethasone (CyDex) (36 cases), bortezomib-cyclophosphamide-dexamethasone (VCD) (10 cases), melphalan-prednisolone (MP) (10 cases), bortezomib-dexamethasone (VD) (4 cases), bortezomib-thalidomide-dexamethasone (VTD) (3 cases) and cyclophosphamide-thalidomide-dexamethasone (CTD) (1 case).

After frontline chemotherapy, the renal response rates for patients receiving steroid and no steroid therapy before chemotherapy were 21.87 and 37.5%, respectively. Among patients who received steroid therapy before chemotherapy and underwent CyDex, VCD, VD and VTD regimens, the renal response rates were 42.9, 35.7, 14.3 and 7.1%, respectively. In contrast, patients not receiving steroid therapy before chemotherapy and treated with CyDex, VCD, VD, VTD, MP and CTD revealed renal response rates of 70.8, 4.2, 4.2, 4.2, 12.5 and 4.2%, respectively. Conclusion: CyDex regimen can be used as frontline therapy for newly diagnosed MM and can improve renal function, particularly in resource-limited settings