Partial recovery of kidney function for an autologous transplant in a patient with chronic kidney disease and multiple myeloma
Recuperación parcial de la función renal tras trasplante autólogo en paciente con enfermedad renal crónica y mieloma múltiple
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DE ALARCÓN JIMÉNEZ, S. ROCA MEROÑO, G.M. ÁLVAREZ FERNÁNDEZ, M.A. GARCÍA HERNÁNDEZ, M.J. NAVARRO PARREÑO, C. JIMENO GRIÑÓ, E. ZARCO PEDRINACI, M. MOLINA NÚÑEZ" "autores" => array:8 [ 0 => array:4 [ "Iniciales" => "R.M." "apellidos" => "DE ALARCÓN JIMÉNEZ" "email" => array:1 [ 0 => "rmalarcon.rosa@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 1 => array:3 [ "Iniciales" => "S." "apellidos" => "ROCA MEROÑO" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 2 => array:3 [ "Iniciales" => "G.M." "apellidos" => "ÁLVAREZ FERNÁNDEZ" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 3 => array:3 [ "Iniciales" => "M.A." "apellidos" => "GARCÍA HERNÁNDEZ" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 4 => array:3 [ "Iniciales" => "M.J." "apellidos" => "NAVARRO PARREÑO" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 5 => array:3 [ "Iniciales" => "C." "apellidos" => "JIMENO GRIÑÓ" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 6 => array:3 [ "Iniciales" => "E." "apellidos" => "ZARCO PEDRINACI" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 7 => array:3 [ "Iniciales" => "M." "apellidos" => "MOLINA NÚÑEZ" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital Universitario Santa María del Rosell, Murcia, " "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Recuperación parcial de la función renal tras trasplante autólogo en paciente con enfermedad renal crónica y mieloma múltiple" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10496_108_15839_en_t4_cartas.jpg" "Alto" => 349 "Ancho" => 600 "Tamanyo" => 164344 ] ] "descripcion" => array:1 [ "en" => "Analytical evolution" ] ] ] "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">To the Editor, </span></p><p class="elsevierStylePara">Multiple myeloma (MM) is a treatable, although incurable disease.<span class="elsevierStyleSup">1-3</span> Its prognosis has improved during recent years, with an average survival of 2-3 years, given a therapeutic change with the advent of autologous haematopoietic progenitor cell transplantation (AHPCT) and three new myeloma drugs: thalidomide, lenalidomide and<span class="elsevierStyleBold"> </span>bortezomib,<span class="elsevierStyleSup">4</span> which have proven to be safe for patients with MM and renal failure.<span class="elsevierStyleSup">1</span></p><p class="elsevierStylePara">Renal failure is one of the main factors associated with the disease’s poor prognosis.<span class="elsevierStyleSup">2</span> I develops in 25%-30% of cases and 2%-3% of them need dialysis, with an average survival rate of between 4 months to a year.<span class="elsevierStyleSup">3,4</span> It has a multifactorial origin, although its most frequent cause is the elimination of light chains (Bence-Jones proteinuria). When it is present in tubules is histologically called “myeloma kidney”.<span class="elsevierStyleSup">1 </span></p><p class="elsevierStylePara">We report the case of a 53-year-old patient, diagnosed with MM IgA lambda stage IIIB according to the Durie Salmon staging system. He presented with acute renal failure, likely to be secondary to myeloma kidney. He was indicated haemodialysis at diagnosis. He started front line chemotherapy with bortezomib, adriamycin and dexamethasone (PAD combination therapy) prior to AHPCT with melphalan, with excellent clinical tolerance, which allowed him to achieve complete remission (CR). However, he had no kidney response. Eleven months after starting the dialysis programme, the patient presented with an improved glomerular filtration rate (GFR) and was able to stop dialysis treatment definitively 14 months after diagnosis (Table 1).</p><p class="elsevierStylePara">The degree of renal dysfunction has an impact on MM patients’ prognosis, especially in those that need dialysis, reporting lower survival rates, higher short-term mortality (estimated 4 months), greater susceptibility to infections, longer hospital stays and greater compromise to the patient’s quality of life. High-dose chemotherapy and AHPCT have traditionally been contraindicated for all of these reasons.<span class="elsevierStyleSup">5</span> However, the treatment of choice is polychemotherapy in patients under 65 years with a generally good condition. As well as dexamethasone, regimens include vincristine, adriamycin and cyclophosphamide, together with new myelomatosis drugs: thalidomide, lenalidomide and bortezomib, followed by AHPCT,<span class="elsevierStyleSup">5,6 </span>as well as dialysis support when necessary, given that it increases the likelihood of CR for 20%-40% of cases. It has a progression-free survival of 2.5-4 years and a general survival of 4-5 years,<span class="elsevierStyleSup">7-9</span> with total or partial GFR recovery in 25%-58%, which entails improved survival.<span class="elsevierStyleSup">4,10 </span></p><p class="elsevierStylePara">Tauro et al, and other authors, have reported that patients who receive chemotherapy and AHPCTs can obtain partial kidney function recovery, reducing their dialysis dose and frequency. However, very few patients are able to definitively stop dialysis following treatment. They also describe that the type of paraprotein used (IgA and IgM are associated with a higher risk of progression than IgG), MM evolution time, and renal failure evolution time influence partial kidney function recovery.<span class="elsevierStyleSup">4,10,11</span></p><p class="elsevierStylePara">Badros et al conducted the first prospective study on MM patients undergoing AHPCT. They reported that patients under 70 years old with MM and renal failure including those on dialysis, should be treated with lower chemotherapy doses (melphalan at 140mg instead of 200mg), as it reduces the incidence of adverse effects. They also describe early AHPCT as being a safe treatment, which increases the likelihood of CR, total or partial GFR recovery, and therefore, overall survival. However, results show that 12 months after renal failure, GFR recovery is highly unlikely.<span class="elsevierStyleSup">4</span></p><p class="elsevierStylePara">Matsue recently published a study on the possibility of reversing dialysis-dependent renal failure, and its relation to light chains. This study considered high-dose dexamethasone to be the gold standard treatment for patients with MM and renal failure, given its rapid response, and that it should be co-administered with new drugs such as thalidomide and bortezomib, which have proven to be greatly effective at treating MM associated with GFR deterioration. In their study, 67% of patients who had been undergoing dialysis for 2 months stopped dialysis following treatment with dexamethasone and thalidomide. Bortezomib was used successfully as a second-line treatment for 3 dialysis-dependent patients, and did not show any major adverse effects. They also observed a greater survival in those patients who had been undergoing dialysis for less than 4 months, and long-term survival similar to patients without renal failure. GFR recovery was therefore associated with a reduction in light chain serum concentration for all patients included in the study. An excess of light chains synthesised by myeloma cells is the main cause of renal function deterioration, as they accumulate in the renal tubules. Rapidly reducing them is therefore of utmost importance for recovering kidney function.<span class="elsevierStyleSup">12</span></p><p class="elsevierStylePara">To conclude, our case reported a patient under 65 years of age, diagnosed with MM IgA stage IIIB (and therefore with greater risk of progression), with severe renal failure at the time of diagnosis and who needed dialysis (low survival and high morbidity and mortality). He obtained CR but had no kidney response. He was indicated a PAD combination regimen and AHPCT + melphalan. He presented with gradual GFR progression a year after diagnosis, and stopped dialysis at 14 months (which is an exceptional case as we have seen in the medical literature review). We are therefore able to conclude that a safe and effective treatment to ensure remission in dialysis-dependent patients is the induction regimen with dexamethasone, alongside a myeloma drug such as bortezomib, before AHPCT and low doses of melphalan, which in addition to a gradual reduction in light chain formation and excretion, promotes GFR recovery, and improves long-term patient survival.</p><p class="elsevierStylePara"><a href="grande/10496_108_15839_en_t4_cartas.jpg" class="elsevierStyleCrossRefs"><img src="10496_108_15839_en_t4_cartas.jpg" alt="Analytical evolution"></img></a></p><p class="elsevierStylePara">Table 1. Analytical evolution</p>" "pdfFichero" => "P1-E518-S2912-A10496-EN.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10496_108_15839_en_t4_cartas.jpg" "Alto" => 349 "Ancho" => 600 "Tamanyo" => 164344 ] ] "descripcion" => array:1 [ "en" => "Analytical evolution" ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:12 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "García Sanz R, Mateos MV, San Miguel JF. Mieloma múltiple. Med Clin (Barc) 2007;129:104-15." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Greipp PR, San Miguel JF, Durie BGM, et al. International Staging System for Multiple Myeloma. J Clin Oncol 2005;23:3412-20." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Knudsen LM, Nielsen B, Gimsing P, et al. Autologous stem cell trasplantation in multiple myeloma: outcome in patients with renal failure. Eur J Haematol 2005;75:27-33. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15946307" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Badros A, Balorgie B, Siegel E, et al. Results of autologous stem cell transplant in multiple\u{A0}myeloma patients with renal failure. Br J Haematol 201;114:822-9." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Blade J, Rosinol L. Renal, hematologic and infections complications in múltiple myeloma. Best Pract Res Clin Haematol 2005;18:635-52. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16026742" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 5 => array:3 [ "identificador" => "bib6" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Irish AB, Winearls CG, Littlewood T. Presentation and supervival of patients with severe renal failure and myeloma. Q J Med 1997;90:773-80." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 6 => array:3 [ "identificador" => "bib7" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Bernardo J, González G, Hernández L. Tratamiento del mieloma múltiple con talidomida y dexametasona: avanzando lentamente. Med Clin (Barc) 2007;128(4):133-4." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 7 => array:3 [ "identificador" => "bib8" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Ashser A, Chanan-Khan A, Kaufman J, et al. Activity and safety of bortezomib in multiple myeloma patients with advanced renal failure: a multicenter retrospective study. Blood 2007;109:2604-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17138816" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 8 => array:3 [ "identificador" => "bib9" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Qayum A, Aleem A, Rehman A, et al. Rapid improvemente in renal function in patients with multiple myeloma and renal failure treated with bortezomib. Saudi J Kidney Dis Transpl 2010;21(1):63-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20061695" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 9 => array:3 [ "identificador" => "bib10" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Alexanian R, Barlogie B, Dixon D, et al. Renal failure in multiple myeloma. Pathogenesis and prognostic implications. Arch Intern Med 1990;150:1693-5. <a href="http://www.ncbi.nlm.nih.gov/pubmed/2383164" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 10 => array:3 [ "identificador" => "bib11" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Tauro S, Clark FJ, Duncan N, et al. Recovery of renal function after autologous stem cell trasplantation in myeloma patients with end-stage renal failure. Bone Marrow Transplant 2002;30:471-3. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12368962" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 11 => array:3 [ "identificador" => "bib12" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Matsue K, Fujiwara H, Iwama K, et al. Reversal of dialysis-dependent renal in patients with advanced multiple myeloma: single institutional experiences over 8 years. Ann Hematol 2010;89:291-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19693498" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000003100000002/v0_201502091641/X2013251411051481/v0_201502091641/en/main.assets" "Apartado" => array:4 [ "identificador" => "35437" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor - Brief Case Reports" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003100000002/v0_201502091641/X2013251411051481/v0_201502091641/en/P1-E518-S2912-A10496-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251411051481?idApp=UINPBA000064" ]
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| 2024 March | 49 | 23 | 72 |
| 2024 February | 45 | 35 | 80 |
| 2024 January | 38 | 28 | 66 |
| 2023 December | 28 | 26 | 54 |
| 2023 November | 43 | 30 | 73 |
| 2023 October | 73 | 37 | 110 |
| 2023 September | 53 | 33 | 86 |
| 2023 August | 22 | 19 | 41 |
| 2023 July | 39 | 26 | 65 |
| 2023 June | 43 | 15 | 58 |
| 2023 May | 44 | 26 | 70 |
| 2023 April | 47 | 20 | 67 |
| 2023 March | 56 | 25 | 81 |
| 2023 February | 56 | 46 | 102 |
| 2023 January | 26 | 20 | 46 |
| 2022 December | 32 | 33 | 65 |
| 2022 November | 31 | 21 | 52 |
| 2022 October | 37 | 40 | 77 |
| 2022 September | 28 | 29 | 57 |
| 2022 August | 47 | 47 | 94 |
| 2022 July | 29 | 45 | 74 |
| 2022 June | 41 | 27 | 68 |
| 2022 May | 44 | 32 | 76 |
| 2022 April | 36 | 44 | 80 |
| 2022 March | 38 | 38 | 76 |
| 2022 February | 47 | 38 | 85 |
| 2022 January | 43 | 27 | 70 |
| 2021 December | 40 | 43 | 83 |
| 2021 November | 63 | 31 | 94 |
| 2021 October | 60 | 51 | 111 |
| 2021 September | 41 | 42 | 83 |
| 2021 August | 57 | 34 | 91 |
| 2021 July | 64 | 27 | 91 |
| 2021 June | 67 | 20 | 87 |
| 2021 May | 97 | 29 | 126 |
| 2021 April | 124 | 34 | 158 |
| 2021 March | 78 | 30 | 108 |
| 2021 February | 55 | 14 | 69 |
| 2021 January | 64 | 23 | 87 |
| 2020 December | 46 | 16 | 62 |
| 2020 November | 24 | 14 | 38 |
| 2020 October | 34 | 17 | 51 |
| 2020 September | 25 | 10 | 35 |
| 2020 August | 36 | 10 | 46 |
| 2020 July | 44 | 7 | 51 |
| 2020 June | 46 | 16 | 62 |
| 2020 May | 54 | 10 | 64 |
| 2020 April | 30 | 19 | 49 |
| 2020 March | 26 | 16 | 42 |
| 2020 February | 43 | 26 | 69 |
| 2020 January | 34 | 25 | 59 |
| 2019 December | 48 | 28 | 76 |
| 2019 November | 38 | 23 | 61 |
| 2019 October | 18 | 9 | 27 |
| 2019 September | 30 | 17 | 47 |
| 2019 August | 17 | 13 | 30 |
| 2019 July | 33 | 23 | 56 |
| 2019 June | 25 | 8 | 33 |
| 2019 May | 27 | 4 | 31 |
| 2019 April | 53 | 23 | 76 |
| 2019 March | 23 | 15 | 38 |
| 2019 February | 13 | 13 | 26 |
| 2019 January | 31 | 15 | 46 |
| 2018 December | 76 | 38 | 114 |
| 2018 November | 97 | 15 | 112 |
| 2018 October | 89 | 13 | 102 |
| 2018 September | 58 | 15 | 73 |
| 2018 August | 28 | 16 | 44 |
| 2018 July | 35 | 7 | 42 |
| 2018 June | 25 | 8 | 33 |
| 2018 May | 47 | 14 | 61 |
| 2018 April | 37 | 7 | 44 |
| 2018 March | 38 | 3 | 41 |
| 2018 February | 40 | 5 | 45 |
| 2018 January | 33 | 5 | 38 |
| 2017 December | 44 | 11 | 55 |
| 2017 November | 50 | 9 | 59 |
| 2017 October | 33 | 7 | 40 |
| 2017 September | 48 | 14 | 62 |
| 2017 August | 37 | 4 | 41 |
| 2017 July | 44 | 13 | 57 |
| 2017 June | 46 | 8 | 54 |
| 2017 May | 44 | 14 | 58 |
| 2017 April | 48 | 15 | 63 |
| 2017 March | 26 | 2 | 28 |
| 2017 February | 27 | 8 | 35 |
| 2017 January | 31 | 5 | 36 |
| 2016 December | 61 | 6 | 67 |
| 2016 November | 82 | 4 | 86 |
| 2016 October | 97 | 13 | 110 |
| 2016 September | 121 | 9 | 130 |
| 2016 August | 238 | 7 | 245 |
| 2016 July | 163 | 9 | 172 |
| 2016 June | 159 | 0 | 159 |
| 2016 May | 151 | 0 | 151 |
| 2016 April | 110 | 0 | 110 |
| 2016 March | 100 | 0 | 100 |
| 2016 February | 113 | 0 | 113 |
| 2016 January | 103 | 0 | 103 |
| 2015 December | 103 | 0 | 103 |
| 2015 November | 84 | 0 | 84 |
| 2015 October | 92 | 0 | 92 |
| 2015 September | 61 | 0 | 61 |
| 2015 August | 78 | 0 | 78 |
| 2015 July | 59 | 0 | 59 |
| 2015 June | 38 | 0 | 38 |
| 2015 May | 59 | 0 | 59 |
| 2015 April | 5 | 0 | 5 |
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