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Renal failure should not exclude patients from undergoing autologous stem cell transplants, as this procedure appears to be safe and effective treatment for patients with multiple myeloma who have renal failure, according to a recent article published in the

British Journal of Haematology.

There are approximately 40,000 people in the United States living with multiple myeloma with 14,000 new cases of multiple myeloma diagnosed each year in the United States, making it the second most common blood cancer. Multiple myeloma is a cancer involving important immune (infection-fighting) cells called plasma cells. Plasma cells aid the body in fighting infection by producing specialized proteins called antibodies that have the ability to target and/or kill foreign cells. In multiple myeloma, cancerous plasma cells produce abnormal and excessive antibodies that do not have the ability to properly fight infection. In addition, the cancerous plasma cells accumulate in the bone marrow, suppressing the normal formation and function of other cells that are necessary for normal production of blood cells and immune functions. The excessive accumulation of cancer cells in the bone marrow ultimately leads to the formation of tumors in the bone and to the breakdown of bone. Standard treatment for multiple myeloma is chemotherapy. High-dose chemotherapy and stem cell transplantation is also an investigative treatment option that has shown promise in achieving sustained responses in patients with multiple myeloma.

High-dose chemotherapy kills more cancer cells than moderate doses of chemotherapy. However, more healthy cells, including stem cells, are also killed due to the high doses, often causing significant side effects. Stem cells are immature blood cells produced in the bone marrow that mature into red blood cells, which carry oxygen to tissues; white blood cells, which fight infection; and platelets, which aid the blood in clotting. Autologous stem cell transplants involve the collection of patient’s stem cells prior to treatment and re-infusion following high-dose therapy to restore depleted blood cell levels.

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Historically, physicians were reluctant to utilize high-dose chemotherapy and stem cell transplants for the treatment of multiple myeloma patients with renal failure, due to the notion that these patients could not tolerate this aggressive therapy. Renal failure is the inability of the kidneys to properly filter waste from the blood, leading to a build-up of toxins in the blood and release of necessary electrolytes in the urine. Renal failure independently led to the exclusion of patients receiving high-dose therapy and stem cell transplants.

Researchers recently conducted a clinical trial evaluating the safety and effectiveness of autologous stem cells transplants in 81 multiple myeloma patients with renal failure. Nearly 40 patients were on dialysis (a procedure in which the blood is filtered through mechanical processes and filters) while receiving treatment. Thirty-eight patients were able to undergo two high-dose chemotherapy courses, 11 of whom were dialysis patients. Death rates due to treatment were 6% following one course of high-dose chemotherapy and 13% following two courses. Complete disappearance of cancer was achieved in 26% of patients following one course of treatment and 38% following two courses. Three years following treatment, 48% of patients had no evidence of cancer and 55% of patients were alive. Dialysis dependence did not affect cancer-free survival or overall survival. Disease that was receptive to chemotherapy, normal albumin levels (protein that is a “marker” for renal disorders) and younger age were independent variables that positively effected survival.

These results indicate that renal failure does not have to exclude multiple myeloma patients from receiving high-dose chemotherapy and autologous stem cell transplants. The findings from this trial demonstrate mortality rates and long-term outcomes for this group of patients comparable to patients who do not have renal failure. Future clinical trials addressing this issue are warranted. Patients with multiple myeloma and renal failure may wish to discuss the risks and benefits of high-dose chemotherapy and stem cell transplants with their physician, or the participation in clinical trials.

(British Journal of Haematology, Vol 114, No 4, pp 822-829, 2001)

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