Compromiso renal como factor pronóstico en pacientes con mieloma múltiple de novo: cohortes retrospectivas, 2015-2020

Abstract

Introduction: Multiple myeloma is the second most common hematologic malignancy, accounting for approximately 1% of all and 10% to 13% of malignancies. Renal involvement may be present at the time of diagnosis in between 30 to 35% of patients, determining a worse prognosis and quality of life during de course of the disease. Currently, in the Colombian population there is no information regarding progression-free survival, therapeutic safety, increased burden of morbidity, and overall survival in patients with multiple myeloma. Objectives: To determine the differences between the outcomes in patients with a diagnosis of de novo multiple myeloma and renal involvement with those without it. Methodology: Retrospective cohort-type analytical observational study of 165 patients diagnosed with de novo multiple myeloma, one cohort with renal involvement and the other without, at an institution in Bogotá for a minimum follow-up period of 2 years. Results: 165 patients diagnosed with de novo multiple myeloma were included, of whom 64 met the criteria for renal involvement and 101 did not. The mean age was 62.76 (SD: 10.44) years. 54% were men and the remaining 46% were women. The mortality rate occurred in 54.5% of men and 46.7% of women. The presence of renal involvement increased mortality by 1.6 times (1.11-2.31) p=<0.05). The variables like the worst scores in the ISS (p=<0.05) mainly ISS III RR 1.75(1.21-2.55;p=<0.05), the presence of a cytogenetic alteration RR 1.61(1.02-2.55;p=0.0368), relapse or progression RR 1.89(1.36-2.62;p=<0.001) was significantly associated with the mortality outcome of the cohorts. Among the quantitative variables, the greatest age with a mean of 67.3 years among those who died RR 5.1(1.86-8.15;p=<0.001), B2 microglobulin, with a median within the patients who died of 5350 pg/ml (IQR : 3050-14120) and in those who did not die it was 3653 pg/ml (IQR: 2520-6040) (p value <0.05). In patients with renal compromise, dialysis at diagnosis increased the risk of death by 2.21 times (1.85-2.64; p=<0.001). It was evidenced as a protective factor for mortality being taken to a transplant RR 0.42(0.3-0.6;p= p=<0.001). The median overall survival of the cohort was 54.5 months (95% CI; 42.7-64.7). The median progression-free survival was 36.9 months (95% CI; 27-62.3). The overall survival of patients who did not undergo bone marrow transplantation was 29.7 months (95% CI; 23.8-49.6) while in those who underwent transplantation it was not determinable. The overall survival of patients with renal compromise was 35.7 months (95% CI; 22.1-62.3) and the progression-free survival in this analyzed group was 19.1 months (95% CI; 11.7-43.3). Conclusions: Among the factors found in the study related to mortality in the patient cohorts were: renal compromise, hypercalcemia, ISS III, the presence of a cytogenetic alteration, relapse or progression, older age, and B2 microglobulin > 5500pg/ml. In patients with renal compromise, dialysis increased the risk of death by 2.21 times. It was evidenced as a protective factor for mortality being taken to a transplant. The frequency of renal compromise was 38.8%, with a dialysis requirement in 24.2%. The patient cohort had a median overall survival and progression-free survival of 54.5 months and 36.9 months, respectively. Patients without renal involvement had a median overall survival of 64.7 months and patients with renal involvement of 35.7 months.