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Autologous stem cell transplantation in multiple myeloma patients with renal impairment

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Abstract

Renal impairment (RI) used to exclude multiple myeloma (MM) patients from autologous stem cell transplantation (ASCT) for safety concerns. Here, we retrospectively reviewed 34 consecutively transplanted patients with creatinine clearance < 60 ml/min at ASCT in recent 5 years at our institution. Busulfan/cyclophosphamide and high-dose melphalan were both employed as conditioning regimens. We found 62% grade 1–2 oral mucositis, 12% grade 3 oral mucositis, 48% grade 3 infection, 8% grade ≥ 4 infection, 50% grade 1 transient creatinine increase, 15% cardiac adverse events, and 12% engraftment syndrome. One case of secondary platelet graft failure and 1 case of transplantation-related mortality were observed. Interleukin-6 concentration was elevated among patients with increased body temperature and/or N-terminal pro-brain natriuretic peptide during engraftment, and close monitoring of these markers may help to predict susceptibility to cardiac events and engraftment syndrome. Adverse events occurred frequently, but the majority were manageable in this cohort. ASCT would further deepen the anti-myeloma efficacy and slightly ameliorated renal function. With a median follow-up of 26.2 months post transplantation (range: 1.6–74.8 months), the median progression-free survival (PFS) and overall survival (OS) post-transplantation of patients undergoing first-line transplantation were not reached; the median PFS post-transplantation of patients undergoing rescue transplantation was 19.2 months and the median OS was not reached.

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Acknowledgements

We wish to thank Qingyuan Wang, Feiran Gong, Jiazi Zhou, and Li Yao for assistance in data collection and verification.

Funding

This study was supported by grants from National Natural Science Foundation of China (81730003 and 82270210), Translational Research Grant of NCRCH (2020ZKPB01), and Suzhou Project of Science and Technology 2021 (SLJ2021004).

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Author notes

  1. Yingying Zhai, Lingzhi Yan and Song Jin have contributed equally to this work and share first authorship.

Authors and Affiliations

  1. National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China

    Yingying Zhai, Lingzhi Yan, Song Jin, Shuang Yan, Weiqin Yao, Jingjing Shang, Xiaolan Shi, Ruju Wang, Huizhu Kang, Jing Lu, Ziling Zhu, Fang Tang, Feng Wei, Chengcheng Fu & Depei Wu

  2. Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China

    Yingying Zhai, Lingzhi Yan, Song Jin, Shuang Yan, Weiqin Yao, Jingjing Shang, Xiaolan Shi, Ruju Wang, Huizhu Kang, Jing Lu, Ziling Zhu, Fang Tang, Feng Wei, Chengcheng Fu & Depei Wu

  3. Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Suzhou, China

    Yingying Zhai, Lingzhi Yan, Song Jin, Shuang Yan, Weiqin Yao, Jingjing Shang, Xiaolan Shi, Ruju Wang, Huizhu Kang, Jing Lu, Ziling Zhu, Fang Tang, Feng Wei, Chengcheng Fu & Depei Wu

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  1. Yingying Zhai
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Contributions

YZ, LY, and SJ designed the study, collected and analyzed the data, and wrote the article. SY, WY, JS, XS, RW, HK, JL, ZZ, FT, and FW contributed to data collection, verification, and analysis. CF and DW contributed to the research design, data analysis, article composition, and study supervision. All authors read and approved the final article.

Corresponding authors

Correspondence to Chengcheng Fu or Depei Wu.

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The studies involving human participants were reviewed and approved by First Affiliated Hospital of Soochow University Research Ethics Board. The patients/participants (or legal guardian/next of kin) provided written informed consent to participate in this study.

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Zhai, Y., Yan, L., Jin, S. et al. Autologous stem cell transplantation in multiple myeloma patients with renal impairment. Ann Hematol 102, 621–628 (2023). https://doi.org/10.1007/s00277-023-05085-w

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