Recommending bortezomib in multiple myeloma patients with poor kidney function

This paper studied the effect of recommending bortezomib as the first drug to use for multiple myeloma in patients with poor kidney function. This study concluded that after bortezomib became the recommended drug, there was an increase in the number of patients who did not require dialysis.

Up to 50% of patients with multiple myeloma have impaired kidney function. About 10% of these patients require dialysis (procedure that takes over kidney function). Bortezomib (Velcade) is a treatment for  multiple myeloma. It has been found to improve kidney function. Because of this, it became recommended as the first drug to use for multiple myeloma in patients with impaired kidney function. This guideline was implemented in the Netherlands in 2010. Few studies have evaluated the effect of bortezomib in multiple myeloma patients who are on dialysis.  

Information on 710 patients with multiple myeloma needing dialysis was extracted from a database. 422 patients started dialysis before the guideline was implemented. 278 patients started dialysis after the guideline was implemented. They were followed-up for an average of 1.2 to 1.3 years.

Before the guideline was started, 11% of patients became dialysis independent (not needing dialysis for at least 2 months) within 4 years of starting dialysis. After the guideline was implemented, 19% of patients became dialysis independent within 4 years of starting dialysis. In the first year, patients who started dialysis after the guideline were 2.3 times more likely to become dialysis independent than those who started dialysis before the guideline. This difference was not present after 1 year. Before the guideline was implemented, the average overall survival (time from treatment until death from any cause) was 1.32 years. After the guideline was implemented, the average overall survival was 1.74 years.

Of the patients who became dialysis independent, 21% eventually resumed dialysis within 4 years.

The authors concluded that more patients became independent of dialysis after bortezomib became the recommended first drug to use in multiple myeloma.

It was not known which patients had received bortezomib.

Talk to your doctor about receiving bortezomib if you are on dialysis.