The results of a recent Greek study indicate that kidney impairment is highly reversible in newly diagnosed multiple myeloma patients treated with regimens containing Velcade, thalidomide, and Revlimid.

Additionally, the Greek researchers found that Velcade ^[1] (bortezomib)-based treatments were associated with a shorter time to response  and higher rates of restoration of kidney function than thalidomide ^[2] (Thalomid)- and Revlimid ^[3] (lenalidomide)-based regimens.

Based on their findings, the researchers recommend that Velcade be used as initial therapy for myeloma patients with kidney impairment.

Dr. Baldeep Wirk of the University of Florida, who was not involved with the study, agreed with the investigators’ assessment.

“Velcade doesn’t need any dose reductions in myeloma with [kidney] failure and works the fastest, which is why it is more effective as frontline therapy for newly diagnosed multiple myeloma with [kidney] failure,” said Dr. Wirk.

Kidney impairment ^[4] is present in approximately 20 percent of multiple myeloma patients at the time of diagnosis.  It is primarily caused by the accumulation of antibody proteins called free light chains, which impairs kidney function.

In myeloma patients, kidney impairment leads to a higher risk of complications following treatment.

The role of novel agents such as Velcade, thalidomide, and Revlimid in myeloma patients with kidney impairment has been previously studied. However, according to the Greek researchers, to date there has been no direct comparison between these three agents with regard to the restoration of kidney function.

Study Design

In the present study, researchers from the University of Athens in Greece sought to compare the impact of novel agent-based regimens on the reversal of kidney impairment.

They retrospectively analyzed data from 133 newly diagnosed multiple myeloma patients with kidney impairment. All of the patients were treated with a novel agent-based regimen between April 2011 and December 2011.

Of the 133 patients included in the analysis, 47 percent received a thalidomide-based regimen, 32 percent a Velcade-based regimen, and 21 percent a Revlimid-based regimen.

Overall, 51 percent of patients had severe kidney impairment, including 7.5 percent who required dialysis.

The median follow-up time was 17.5 months.

Novel Agents And Kidney Response

Compared to patients treated with thalidomide or Revlimid, those who received Velcade-based therapy demonstrated a higher probability of restoring kidney function and a shorter time to kidney response.

Significant improvements in kidney function occurred in 77 percent of patients treated with Velcade, 55 percent treated with thalidomide, and 43 percent treated with Revlimid.

Specifically, 67 percent of Velcade-treated patients achieved a complete kidney response, as compared to 53 percent of thalidomide-treated patients and 36 percent of Revlimid treated patients.

Among patients who required dialysis at the time of diagnosis, 50 percent were able to stop dialysis after treatment with a novel agent.

Patients who received Velcade achieved at least a partial kidney response in a median of 1.3 months, compared to 2.7 months for patients who received thalidomide and over 6 months for patients who received Revlimid.

The researchers also found that receiving higher initial doses of dexamethasone was associated with a faster response time.  Patients who received more than 160 mg of dexamethasone in the first month of treatment experienced improved kidney function in a median of 1.6 months, compared to a time to response of more than 6 months in patients who received a lower dose.

However, the investigators cautioned that high doses of dexamethasone might be poorly tolerated, especially in older patients.

Myeloma Response And Kidney Response

A partial myeloma response or better was achieved in 81 percent of Velcade-treated patients, 82 percent of Revlimid-treated patients, and 63 percent of thalidomide-treated patients.

Those who achieved at least a partial myeloma response demonstrated a higher probability of achieving at least a partial kidney response as well.

Kidney Response And Overall Survival

The median overall survival time was 44 months for all patients included in the analysis. Patients who received Revlimid had the longest median overall survival (63 months), followed by patients who received Velcade (53 months), and patients who received thalidomide (36 months).

The researchers did not find any significant difference in overall survival between patients who did and those who did not achieve a kidney response.

Overall, 7.5 percent of patients died within the first two months of the start of initial therapy, including 7 percent treated with Velcade, 4 percent treated with Revlimid, and 10 percent treated with thalidomide.

For more information, please see the study in Leukemia ^[5] (abstract).