Reversibility and survival of patients with multiple myelom and renal failure according to the stages of renal failure after systemic treatment

Introduction and Objective: Renal failure is a common complication that causes significant morbidity in MM patients. Improvement in renal function tests during myeloma treatment in patients with renal failure at the time of admission was associated with increased treatment response, and it was observed that survival time was prolonged in these patients compared to those whose kidney function tests did not improve. Since there are few studies on this subject in the literature, we planned to investigate the effect of these markers on response to treatment and survival to the literature Methods and Materials: In our retrospective study, 111 MM patients who applied to our hospital between 2015 and 2023 retrospectively from the electronic information management system of our hospital; Age, gender, date of birth, date of diagnosis, whether there was kidney failure at the time of diagnosis, whether he was on dialysis, whether he had a bone marrow transplant, whether he continued to live, date of death, ISS staging, beta2 microglobulin, immunoglobulins, hemoglobin, blood urea nitrogen, creatinine, GFR rate, renal failure stage, lactate dehydrogenase values of <40 ml/dkmin, lactate dehydrogenase >40 ml/dCmin, lactate dehydrogenase values were evaluated and the results were evaluated. /none, renal failure was divided into groups as regressed and nonregressed. Descriptive statistics are presented with frequency, percentage, mean, standard deviation, median, minimum, maximum, 25%-75% percentile (Q1-Q3) values. In the analysis of the difference between the numerical data of the two groups, the Independent Samples t-test was used when the data conformed to the normal distribution, and the Mann-Whitney U-Test was used when it did not. Changes of laboratory parameters between GFR groups according to time (diagnosis, 6th month, 1st year) between subjects repeated measures ANOVA test was used. SPSS 23.0 Windows version package program was used in the analysis. P<0.05 was considered significant. Results: Results: The study was conducted with a total of 111 MM patients. 56 of the patients (50.5%) were female, mean age was 68±11.1 years. IgG kappa type in 40 (36%) patients, IgG lambda type in 20 (18%) patients, IgA kappa type in 16 (14.4%) patients, IgA lambda type in 5 (4.5%) patients, light chain type in 29 (26.1%) patients, and heavy chain type MM in 1 patient (0.9%). . Mortality was seen in a total of 56 (50.5%) patients. The survival time was found to be 941±691 days. The most frequently chosen type of chemotherapy was VCD. OKIT was performed in 42 (37.8%) patients. While MM-related HD was seen in 12 (10.8%) patients, 6 (33.3%) of the patients who underwent dialysis survived dialysis. The creatinine, GFR and Ig values at the time of diagnosis, at the 6th and 12th months were compared. Mortality was significantly higher in the group that did not undergo OCT (p=0.015). Survival time was also significantly shorter in the group without OKIT (p=0.001). The GFR 1st Year value was significantly higher in the OKIT group (p=0.013). Mortality was observed in 32 (60.4%) patients in the group with regression in CKD stage, and in 23 (40.4%) patients in the group without regression in CKD stage. Mortality was significantly lower in the group without regression in CKD stage (p=0.036). light chain from MM types; It was seen significantly more in the group with regression in CKD stage (p=0.010). Hypercalcemia at the time of diagnosis was significantly more common in the group with regression in CKD stage (p=0.010). There was a significant difference in the course of creatinine and IgG levels over time between the GFR groups. The decrease in creatinine between the time of diagnosis and the 6th month was significantly higher in the GFR≤40 ml/dk group than in the GFR>40 ml/dk group (p=0.002) On the other hand, it was determined that the IgG level decreased significantly more in the GFR>40 group between the time of diagnosis and the 6th month compared to the GFR≤40 group (p=0.007) Discussion and Conclusion: It is thought that the advanced stage of renal failure at the time of diagnosis affects survival and mortality. Decrease in creatinine values and increase in GFR values were observed as a response to treatment. At the same time, quantitative decrease was observed in immunoglobin values in direct proportion. Decrease in renal failure stage was found to be associated with response to treatment. This is due to the fact that we have a single-center clinical study, comorbidities are present in most of the patients and the causes of death of the patients are not known exactly. There is a need for a detailed clinical study in which the number of people is higher and the causes of death are clearly known. Keywords: Multiple myeloma, overall survival, autologous stem cell transplantation, renal failure