NEVES, Manuel et al. Renal impairment at presentation is not an adverse prognostic factor in multiple myeloma patients treated with new agents. []. , 28, 4, pp.318-324. ISSN 0872-0169.

^len^aFifteen to forty per cent of multiple myeloma patients have renal impairment at diagnosis. The Durie-Salmon staging included renal impairment as an adverse prognostic factor and so does the International Staging System, since β2-microglobulin correlates with both tumour burden and renal impairment. However, the introduction of new therapeutic agents (as bortezomib, lenalidomide, and thalidomide) and new prognostic factors, such as cytogenetics, changed that view. With this paper, we intended to study the prognostic impact of renal insufficiency at presentation in patients with multiple myeloma treated with new agents. We retrospectively analysed, from July 2004 to December 2012, multiple myeloma patients treated in first line with bortezomib or thalidomide, in whom cytogenetic study was performed. Renal insufficiency was defined as creatinine clearance < 30mL/min, using the Cockcroft-Gault equation. We treated 174 patients, 54 with thalidomide (31%), 120 with bortezomib (69%). Eighty-eight patients were submitted to autologous stem-cell transplantation. Male sex = 50%, median age = 66 years (22-83). There were 13.4% of light chain myelomas. Creatinine clearance < 30mL/min in 20.1% of patients. International Staging System: I = 39.1%; II = 28.7% and III = 32.2%. High-risk cytogenetics = 35.1%. Median follow-up = 30 months, median overall survival = 83 months. In univariate analysis, the median overall survival was higher for patients without renal impairment compared to patients with renal impairment (83 vs. 40 months, p = 0.004). However, in multivariate analysis with the International Staging System and high-risk cytogenetics, renal impairment does not affect the overall survival. We concluded that renal impairment at presentation is not a prognostic factor in multiple myeloma patients treated in first line with new therapeutic agents.^lpt^aQuinze a 40% dos doentes com mieloma multiplo apresentam-se com insuficiencia renal ao diagnostico. O estadiamento de Durie-Salmon considerava a insuficiencia renal factor de mau prognostico e, actualmente, tambem o International Staging System, ja que a β2-microglobulina se correlaciona tanto com a cargatumoral como com a insuficiencia renal. Contudo, a introducao de novos agentes (como bortezomib, lenalidomida e talidomida) e o aparecimento de outros factores de prognostico, como a citogenetica, mudaram esse panorama. Pretendeu-se, com este estudo, caracterizar a importancia prognostica da insuficiencia renal a apresentacao nos doentes com mieloma multiplo tratados com novos agentes. Analisamos retrospectivamente, entre Julho 2004 e Dezembro 2012, todos os doentes com mieloma multiplo de novo tratados em primeira linha com bortezomib ou talidomida e com estudo citogenetico. Insuficiencia renal caracterizada como clearance de creatinina < 30mL/min, calculada pela equacao de Cockcroft-Gault. Foram tratados 174 doentes, 54 com talidomida (31%)120 com bortezomib (69%), 88 dos quais seguiram depois para auto transplante. Sexo masculino = 50% e mediana de idades = 66 anos (22-83). Mieloma multiplo de cadeias leves em 13,4%. Clearance creatinina < 30mL/min em 20,1% dos doentes. International Staging System: I = 39,1%; II = 28,7% e III = 32,2%. Citogenetica de alto risco = 35,1%. Mediana de follow-up 30 meses, mediana de sobrevivencia global 83 meses. Em analise univariada constata-se diferenca estatisticamente significativa entre a sobrevivencia global dos doentes com insuficiencia renal (mediana 40 meses) e sem insuficiencia renal (mediana 83 meses), p = 0,004. No entanto, num modelo multivariavel de Cox, a insuficiência renal nao influencia a sobrevivencia global quando ajustada para o estadiamento International Staging System e a existencia de citogenetica de alto risco. Concluimos que a insuficiencia renal nao e factor prognostico em doentes com mieloma multiplo tratados em primeira linha com novos agentes

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