GFR estimation in lenalidomide treatment of multiple myeloma patients: a prospective cohort study
The estimated glomerular filtration rate (eGFR) is clinically used to approximate renal function and adapt drug dosage. Multiple myeloma is a hematological disease; its prognosis is largely influenced by renal function. We evaluated two commonly used GFR estimations, CKD-EPI and MDRD (CKD Epidemiology Collaboration; Modification of Diet in Renal Disease) in myeloma patients undergoing treatment with lenalidomide, a renally excreted immunomodulatory drug.
We prospectively studied 130 myeloma patients receiving lenalidomide treatment at our institution. At baseline and after 3 months, GFR estimations were performed based on the CKD-EPI and MDRD equations. We compared eGFR-dependent CKD staging and lenalidomide dosage assignments.
Initially, most patients were classified as CKD stage I/II, using both equations. Comparison of baseline renal function via CKD-EPI and MDRD induced concordance of CKD staging in 83% of patients, while CKD-EPI improved CKD staging in 16% of patients (p = 0.11). CKD-EPI assigned 3% of patients to higher lenalidomide dosing as opposed to MDRD. Both equations showed improved eGFR after 3 months of lenalidomide treatment.
In our multiple myeloma patient cohort, CKD-EPI and MDRD led to similar CKD staging with minor differences in lenalidomide dosage assignment. Consistent with previous studies, eGFR improved under lenalidomide treatment. To standardize GFR estimation in myeloma patients, we suggest using the CKD-EPI equation.
KeywordseGFR Multiple myeloma Lenalidomide Modification of diet in renal disease (MDRD) Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI)
The authors thank Prof. Dr. Hermann Einsele, University of Würzburg, Prof. Dr. Pieter Sonneveld, Erasmus MC Rotterdam, Prof. Dr. Christian Straka, Schön Clinic Starnberger See, Prof. Dr. Keith Stewart, Mayo Clinic Arizona & Rochester, Prof. Dr. Torben Plesner, Center Lillebaelt University of Southern Denmark and Prof. Dr. Justus Duyster, University of Freiburg, for their significant support, fruitful discussion and valuable suggestions. We are also highly obliged to the fruitful discussion with DSMM, GMMG, GIMEMA, EMN and IMWG myeloma experts. This work was supported by a restricted educational grant of Celgene and the Deutsche Krebshilfe (grants 1095969 and 111424 [to ME and RW]).
AS, JG, MK, GI, ME, SZ performed the analysis; AS, JG, ET, GI, HR, RW, ME, SZ analyzed results; AS, JG, MK, ME, SZ prepared tables and figures; ME, RW, designed the research and AS, JG, ME, SZ wrote the paper. All authors approved the manuscript.
Compliance with ethical standards
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee at which the studies were conducted (IRB approval number EK 27/1/14) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
Conflict of interest
The authors declare no competing financial interest. Our manuscript has not been published in any other scientific journal, nor has it been or will it be submitted or published elsewhere while being under consideration by Clinical and Experimental Nephrology.
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