Melphalan 200 mg/m2 with blood stem cell support as first-line myeloma therapy: impact of glomerular filtration rate on engraftment, transplantation-related toxicity and survival

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Abstract
In this retrospective single-centre study, 96 consecutive myeloma patients were treated with melphalan 200 mg/m2 with blood stem cell support as first-line therapy. Their mean age was 55 (38–65) years. The impact of renal function on stem cell collection yield, engraftment, transplantation-related toxicity and overall survival was studied. Glomerular filtration rate (GFR) was evaluated by iohexol clearance, a median 32 days before high-dose administration. Chronic renal failure (GFR <60 ml/min) was present in 19 patients, with severe failure (GFR <30 ml/min) in five patients, including one patient on haemodialysis. No relationship between GFR and stem cell collection yield or engraftment was observed, nor was the incidence of neutropenic fever or infectious complications related to GFR. Patients with subnormal renal function, however, were more often affected by severe mucositis. In addition, the two patients with severe GI bleeding, the two pneumonia patients who needed ventilator support and the only therapy-related death were noted in the five patients with severe renal failure. Lower iohexol clearance at the time of high-dose administration was found to have a poor impact on survival. A reduction of melphalan dose in patients with severe renal failure, here defined as iohexol clerarance <30 ml/min, is suggested.