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International Journal of Hematology

, Volume 108, Issue 4, pp 423–431 | Cite as

Lower glomerular filtration rate predicts increased hepatic and mucosal toxicity in myeloma patients treated with high-dose melphalan

  • Masaharu Tamaki
  • Hideki Nakasone
  • Ayumi Gomyo
  • Jin Hayakawa
  • Yu Akahoshi
  • Naonori Harada
  • Machiko Kusuda
  • Yuko Ishihara
  • Koji Kawamura
  • Aki Tanihara
  • Miki Sato
  • Kiriko Terasako-Saito
  • Kazuaki Kameda
  • Hidenori Wada
  • Misato Kikuchi
  • Shun-ichi Kimura
  • Shinichi Kako
  • Yoshinobu Kanda
Original Article

Abstract

High-dose melphalan followed by autologous hematopoietic stem cell transplantation (ASCT) is a standard treatment for younger myeloma patients. However, the correlation between its toxicity and renal impairment is not clear. We analyzed this relationship, focusing on estimated glomerular filtration rate (eGFR) as an index of renal function. We evaluated 78 multiple myeloma patients who underwent ASCT following high-dose melphalan at our center. Patients were divided into a higher eGFR group (eGFR ≥ 60) and a lower eGFR group (eGFR < 60). Multivariate analyses revealed that lower eGFR was independently associated with alkaline phosphatase elevation (OR 10.2, P = 0.038), mucositis (OR 10.5, P = 0.032), grade 2–4 co-elevation of both aspartate aminotransferase and alanine aminotransferase (OR 21.3, P = 0.016), delay of reticulocyte engraftment (HR 0.524, P = 0.034), and delay of platelet engraftment (HR 0.535, P = 0.0016). However, lower eGFR was not correlated with overall survival or time-to-next treatment. In summary, renal dysfunction secondary to administration of high-dose melphalan was associated with increased hepatic and mucosal toxicity and delay of hematological recovery, but did not affect survival outcomes.

Keywords

Multiple myeloma Estimated GFR Autologous transplantation Melphalan 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare no conflict of interest.

Supplementary material

12185_2018_2507_MOESM1_ESM.docx (19 kb)
Supplementary material 1 (DOCX 19 KB)

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Copyright information

© The Japanese Society of Hematology 2018

Authors and Affiliations

  • Masaharu Tamaki
    • 1
  • Hideki Nakasone
    • 1
  • Ayumi Gomyo
    • 1
  • Jin Hayakawa
    • 1
  • Yu Akahoshi
    • 1
  • Naonori Harada
    • 1
  • Machiko Kusuda
    • 1
  • Yuko Ishihara
    • 1
  • Koji Kawamura
    • 1
  • Aki Tanihara
    • 1
  • Miki Sato
    • 1
  • Kiriko Terasako-Saito
    • 1
  • Kazuaki Kameda
    • 1
  • Hidenori Wada
    • 1
  • Misato Kikuchi
    • 1
  • Shun-ichi Kimura
    • 1
  • Shinichi Kako
    • 1
  • Yoshinobu Kanda
    • 1
  1. 1.Division of Hematology, Saitama Medical CenterJichi Medical UniversitySaitamaJapan

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