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Clinical and Experimental Nephrology

, Volume 23, Issue 2, pp 199–206 | Cite as

GFR estimation in lenalidomide treatment of multiple myeloma patients: a prospective cohort study

  • Andrea Schmidts
  • Julian Grünewald
  • Martina Kleber
  • Evangelos Terpos
  • Gabriele Ihorst
  • Heike Reinhardt
  • Gerd Walz
  • Ralph Wäsch
  • Monika EngelhardtEmail author
  • Stefan ZschiedrichEmail author
Original article

Abstract

Background

The estimated glomerular filtration rate (eGFR) is clinically used to approximate renal function and adapt drug dosage. Multiple myeloma is a hematological disease; its prognosis is largely influenced by renal function. We evaluated two commonly used GFR estimations, CKD-EPI and MDRD (CKD Epidemiology Collaboration; Modification of Diet in Renal Disease) in myeloma patients undergoing treatment with lenalidomide, a renally excreted immunomodulatory drug.

Methods

We prospectively studied 130 myeloma patients receiving lenalidomide treatment at our institution. At baseline and after 3 months, GFR estimations were performed based on the CKD-EPI and MDRD equations. We compared eGFR-dependent CKD staging and lenalidomide dosage assignments.

Results

Initially, most patients were classified as CKD stage I/II, using both equations. Comparison of baseline renal function via CKD-EPI and MDRD induced concordance of CKD staging in 83% of patients, while CKD-EPI improved CKD staging in 16% of patients (p = 0.11). CKD-EPI assigned 3% of patients to higher lenalidomide dosing as opposed to MDRD. Both equations showed improved eGFR after 3 months of lenalidomide treatment.

Conclusions

In our multiple myeloma patient cohort, CKD-EPI and MDRD led to similar CKD staging with minor differences in lenalidomide dosage assignment. Consistent with previous studies, eGFR improved under lenalidomide treatment. To standardize GFR estimation in myeloma patients, we suggest using the CKD-EPI equation.

Keywords

eGFR Multiple myeloma Lenalidomide Modification of diet in renal disease (MDRD) Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) 

Notes

Acknowledgements

The authors thank Prof. Dr. Hermann Einsele, University of Würzburg, Prof. Dr. Pieter Sonneveld, Erasmus MC Rotterdam, Prof. Dr. Christian Straka, Schön Clinic Starnberger See, Prof. Dr. Keith Stewart, Mayo Clinic Arizona & Rochester, Prof. Dr. Torben Plesner, Center Lillebaelt University of Southern Denmark and Prof. Dr. Justus Duyster, University of Freiburg, for their significant support, fruitful discussion and valuable suggestions. We are also highly obliged to the fruitful discussion with DSMM, GMMG, GIMEMA, EMN and IMWG myeloma experts. This work was supported by a restricted educational grant of Celgene and the Deutsche Krebshilfe (grants 1095969 and 111424 [to ME and RW]).

Author Contributions

AS, JG, MK, GI, ME, SZ performed the analysis; AS, JG, ET, GI, HR, RW, ME, SZ analyzed results; AS, JG, MK, ME, SZ prepared tables and figures; ME, RW, designed the research and AS, JG, ME, SZ wrote the paper. All authors approved the manuscript.

Compliance with ethical standards

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee at which the studies were conducted (IRB approval number EK 27/1/14) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Conflict of interest

The authors declare no competing financial interest. Our manuscript has not been published in any other scientific journal, nor has it been or will it be submitted or published elsewhere while being under consideration by Clinical and Experimental Nephrology.

Supplementary material

10157_2018_1626_MOESM1_ESM.pdf (845 kb)
Supplementary material 1 (PDF 845 KB)

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Copyright information

© Japanese Society of Nephrology 2018

Authors and Affiliations

  • Andrea Schmidts
    • 1
  • Julian Grünewald
    • 2
  • Martina Kleber
    • 3
    • 4
  • Evangelos Terpos
    • 5
  • Gabriele Ihorst
    • 6
  • Heike Reinhardt
    • 1
  • Gerd Walz
    • 2
  • Ralph Wäsch
    • 1
  • Monika Engelhardt
    • 1
    Email author
  • Stefan Zschiedrich
    • 2
    Email author
  1. 1.Department of Hematology, Oncology and Stem Cell Transplantation, Medical Center - University of Freiburg, Faculty of MedicineUniversity of FreiburgFreiburgGermany
  2. 2.Department of Nephrology and Primary Care, Medical Center - University of Freiburg, Faculty of MedicineUniversity of FreiburgFreiburgGermany
  3. 3.Divisions of HematologyUniversity Hospital BaselBaselSwitzerland
  4. 4.Department of Internal MedicineUniversity Hospital BaselBaselSwitzerland
  5. 5.Department of Clinical Therapeutics, School of MedicineUniversity of AthensAthensGreece
  6. 6.Clinical Trials Unit, Medical Center - University of Freiburg, Faculty of MedicineUniversity of FreiburgFreiburgGermany

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