¹ A.C.Camargo Câncer Center, São Paulo, Brazil and ² Universidade Nove de Julho – Campus Vergueiro, São Paulo, Brazil
Multiple myeloma (MM) has an average survival of seven years after chemotherapy and autologous bone marrow transplantation (BMT), being a common renal dysfunction associated with an early mortality. Currently, the most used scores to assess the prognosis of MM are Durie and Salmon (DS) and International Staging System (ISS) and there are few records of the work of these scores predicting renal damage after ABMT. Aims: to evaluate the scores of prognosis ISS and DS in renal function and mortality in patients with post BMT
Retrospective, observational cohort with 95 patients with MM who underwent BMT between 2012 and 2014. Data analyzed: age, sex, proteinuria, creatinine and glomerular filtration rate estimated by CKD EPI (eGFR) at admission, BMT, and one for six months after discharge from hospital; occurrence of death. To evaluate the best score, were selected patients with validated data according to DS and ISS in the period before BMT. The accuracy of these scores was evaluated in the prediction of outcomes and defined as: eGFR < 90mL/min 6 months after BMT and
worsening of the CKD stage. Statistical analyzes performed with IBM SPSS 20.0
Sixty-two patients were analyzed in relation to DS, being 51.6% male and 55.2 ± 8.3 years. Of these, 62.9% were in Stage IIIA, 22.6% in Stage I or II and 14.5% in Stage IIIB. The eGFR was 113.2 ± 40.0mL/min and 75.8% had eGFR 90mL/min. In relation to ISS (n = 54), 53.7% were males, with 55.7 ± 7.4 years, with 53.7% being classified in Stages II and III. The eGFR was 111.6 ± 40.1mL/min and 75.9% eGFR 90mL/min. When comparing the scores in relation to renal function, it was observed that 17.5% presented a decline in function (n = 10) and a change in the classification of CKD. Also, 5.2% presented improvement of the classification (n = 3). About death and proteinuria 6 months after BMT, both scores showed no significant association. The patients classified in Stage DS IIIB presented a 12.8 times greater chance of renal dysfunction after BMT, when compared to patients classified in Stage I-II DS
None of the prognostic scores showed a good accuracy in predicting the outcomes studied, although an increase in the chance of impairment of renal function is observed, according to the worst staging defined by DS and ISS at the time