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Cyclophosphamide-containing regimen (TCD) is superior to melphalan-containing regimen (MPT) in elderly multiple myeloma patients with renal impairment

 Moo-Kon Song  ;  Joo-Seop Chung  ;  Ho-Jin Shin  ;  Joon-Ho Moon  ;  Je-Jung Lee  ;  Sung-Soo Yoon  ;  Jin-Seok Kim  ;  Jeong-Ok Lee  ;  Young-Rok Do  ;  Ho-Sup Lee  ;  Eun-Kyung Park 
 ANNALS OF HEMATOLOGY, Vol.91(6) : 889-896, 2012 
Journal Title
Issue Date
Aged* ; Aged, 80 and over ; Antineoplastic Combined Chemotherapy Protocols/adverse effects ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use* ; Creatinine/blood ; Cyclophosphamide/administration & dosage* ; Cyclophosphamide/adverse effects ; Disease-Free Survival ; Female ; Glomerular Filtration Rate/drug effects ; Humans ; Male ; Melphalan/administration & dosage* ; Melphalan/adverse effects ; Multiple Myeloma/blood ; Multiple Myeloma/complications ; Multiple Myeloma/drug therapy* ; Multiple Myeloma/physiopathology ; Renal Insufficiency/blood ; Renal Insufficiency/complications ; Renal Insufficiency/drug therapy* ; Renal Insufficiency/physiopathology ; Retrospective Studies ; Treatment Outcome
Multiple myeloma ; Melphalan ; Cyclophosphamide
Renal impairment (RI) is a frequent complication with higher incidence of infections and an important prognostic factor for survival. Melphalan clearance is renal function dependent whereas cyclophosphamide is renal function independent. We investigated which combination regimen should be selected between melphalan-combining regimen (MPT) or cyclophosphamide-combining regimen (TCD) in elderly multiple myeloma (MM) patients with RI. Between 2005 and 2009, 157 newly diagnosed MM patients with RI were included comparing MPT with TCD therapy as initial treatment. Seventy-four patients were given MPT regimen, and 83 patients were given TCD regimen. Baseline characteristics were similar between the MPT and TCD groups. Analysis of different cutoff levels between 25% and 75% quartiles using log-rank test determined that glomerular filtration rate (GFR), 40 ml/min/1.73 m2 as the cutoff point, yielded the highest difference in event-free survival (EFS) and overall survival (OS). The MPT subgroup with low GFR (GFR <40 ml/min/1.73 m2) had poorer response rates than others. The incidence of neutropenia and infection with febrile neutropenia were higher in the MPT subgroup with low GFR than the others (p = 0.016, p < 0.001). Furthermore, mortality due to the infection was higher in the MPT subgroup with low GFR than the others (p < 0.001). EFS was lower in the MPT subgroup with low GFR than the others (p < 0.001). OS was lower in the MPT subgroup with low GFR than the others (p < 0.001). In newly diagnosed elderly MM patients with RI, TCD regimen would be an effective and tolerable treatment option due to the combination of cyclophosphamide independent to renal function and dexamethasone effective for RI
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Jin Seok(김진석) ORCID logo https://orcid.org/0000-0001-8986-8436
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