Incidence et impact de l’atteinte rénale sur le devenir des patients suivis pour un Myélome Multiple de 2002 à 2017 dans le département de la Gironde

Abstract : Background: renal impairment (RI), a common and severe complication in multiple myeloma (MM), is considered as a poor prognostic factor. MM incidence is increasing worldwide. Patients’ survival has increased in the last decade with the use of novel drugs and autologous stem cell transplantation (ASCT). However, specific evolution of the incidence of MM with RI and its impact on prognosis remain unclear. Methods: two studies were conducted. Using a population-based registry of 1038 newly-diagnosed MM in Gironde from 2002 to 2015, we evaluated the incidence trends of RI in MM patients, and assessed standardized net survival according to factors of interest using Pohar Perme method. To complete these data with specific nephrologic parameters, we reviewed 114 cases of MM with RI followed in Bordeaux’s Nephrology reference center from 2002 to 2017 to precisely describe their clinical outcomes. Results: in our population-based study, 24.6% of patients presented with RI. 12.9% of them required hemodialysis. Incidence trends in patients with RI were not significantly different from patients without RI. Median survival time was 21 months in patients with RI vs not reached at three years for other patients (p<0.01). Age >73 years, RI, Adult Comorbidity Evaluation index 27 score 2-3, and absence of use of bortezomib, immunomodulatory drugs or ASCT were associated with excess mortality risk. The effect of RI on excess mortality rates was maximum in the first six months after diagnosis. Factors associated with renal response identified in multivariate analysis, in our observational study, were hematologic response [Odds ratio (OR) 6.81, 95% confidence interval (CI) 2.33-22.88 p<0.01] and previous chronic kidney disease (OR 0.26, 95% CI 0.06-0.93, p=0.04). Median follow-up time was 22.5 months. Factors associated with one-year overall survival in the Cox model were hematological response (Hazard ratio (HR) 0.13, 95% CI 0.03-0.43, p<0.01) and renal response (HR 0.27, 95% CI 0.06-0.90, p=0.03). In 38 patients requiring long-term hemodialysis, median survival time was 12 months, compared to 50 months in other patients (p<0.01). Conclusion: RI represents an independent negative prognostic factor in MM patients, mostly in the first 6 months after diagnosis. Triple-molecule regimens and ASCT eligibility should be largely discussed in patients with RI, as renal recovery and hematologic response are the strongest markers associated with patient survival.
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Master Thesis
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Maxime Courant. Incidence et impact de l’atteinte rénale sur le devenir des patients suivis pour un Myélome Multiple de 2002 à 2017 dans le département de la Gironde. Médecine humaine et pathologie. 2018. ⟨dumas-02091505⟩

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