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, Jinseok Kim, Jeong Ok Lee, Young Rok Do, Ho Sup Lee, Eun Kyung Park

Research output: Contribution to journalArticle

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Abstract

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 m 2 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 m 2) 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.

Original languageEnglish
Pages (from-to)889-896
Number of pages8
JournalAnnals of Hematology
Volume91
Issue number6
DOIs
Publication statusPublished - 2012 Jun 1

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Melphalan
Multiple Myeloma
Cyclophosphamide
Glomerular Filtration Rate
Kidney
Disease-Free Survival
Survival
Infection
Febrile Neutropenia
Incidence
Neutropenia
Dexamethasone
Therapeutics
Mortality

All Science Journal Classification (ASJC) codes

  • Hematology

Cite this

Song, Moo Kon ; Chung, Joo Seop ; Shin, Ho Jin ; Moon, Joon Ho ; Lee, Je Jung ; Yoon, Sung Soo ; Kim, Jinseok ; Lee, Jeong Ok ; Do, Young Rok ; Lee, Ho Sup ; Park, Eun Kyung. / Cyclophosphamide-containing regimen (TCD) is superior to melphalan-containing regimen (MPT) in elderly multiple myeloma patients with renal impairment. In: Annals of Hematology. 2012 ; Vol. 91, No. 6. pp. 889-896.
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title = "Cyclophosphamide-containing regimen (TCD) is superior to melphalan-containing regimen (MPT) in elderly multiple myeloma patients with renal impairment",
abstract = "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 m 2 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 m 2) 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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Cyclophosphamide-containing regimen (TCD) is superior to melphalan-containing regimen (MPT) in elderly multiple myeloma patients with renal impairment. / Song, Moo Kon; Chung, Joo Seop; Shin, Ho Jin; Moon, Joon Ho; Lee, Je Jung; Yoon, Sung Soo; Kim, Jinseok; Lee, Jeong Ok; Do, Young Rok; Lee, Ho Sup; Park, Eun Kyung.

In: Annals of Hematology, Vol. 91, No. 6, 01.06.2012, p. 889-896.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Cyclophosphamide-containing regimen (TCD) is superior to melphalan-containing regimen (MPT) in elderly multiple myeloma patients with renal impairment

AU - Song, Moo Kon

AU - Chung, Joo Seop

AU - Shin, Ho Jin

AU - Moon, Joon Ho

AU - Lee, Je Jung

AU - Yoon, Sung Soo

AU - Kim, Jinseok

AU - Lee, Jeong Ok

AU - Do, Young Rok

AU - Lee, Ho Sup

AU - Park, Eun Kyung

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N2 - 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 m 2 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 m 2) 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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