Reversal of advanced renal dysfunction on bortezomib treatment in multiple myeloma patients

Abstract

6714 Background: Bortezomib is a highly active agent in multiple myeloma. Advanced stages of multiple myeloma are freqeuntly associated with progressive renal failure. We report here 6 cases of acute advanced deterioration of renal function on prior renal insuficiency in chronic MM patients, with complete or near complete reversal of severe renal dysfunction after treatment with Velcade and Dexamethasone. Methods: Pts received Velcade 1.0 mg/m2/d IV d1,4,8,11 and Dexamethasone 20 mg IV d1,4,8,11. Results: Rapid reversal of acute deterioration of renal dysunction was demonstrated after treatment with Velcade and Dexamethasone in this retrospective review of patient cases. Improvement of renal function was generally evident quickly, often less than 2 weeks, earlier than expected from general myeloma tumor response. A review of a trial of treatment with Velcade where Dexamethasone was added in later cycles may address possible evidence of synergy of Velcade and dexamethasone in reversal of renal dysfunction. Animal models suggest NFkB, the target of Bortezomib, is upregulated in acute tubular injury from proteinuria and suggest further study of this drug’s possible role in protecting renal function. Conclusions: In summary, rapid and at times dramatic reversal of severe renal dysfunction is seen with Velcade and Dexamethasone, sparing the 6 patients above from imminent dialysis. Prevention of end stage renal failure is an important clinical goal given the prolonged survivals seen in myleoma patients in the current era, and the known impact of renal failure on their survival. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Millennium Millennium