Renal response and safety in real world of bortezomib treatment in newly diagnosed multiple myeloma patients with renal impairment

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METHODS: We retrospective evaluated NDMM patients with RI at the Second Hospital of Shandong University between between January 2019 and December 2022.RI was defined as having a estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m 2 . RESULTS: There were 28 patients inclused, and the mean eGFR was 24.40mL/min/1.73 m 2 . All patients received a total of 77 courses of bortezomib-based therapy, and 87.01% regimens were three-drug combinations. The renal responce rates were 67.86%, 76.19%, 75.00%, and 76.92% from the first to forth courses, respectively, and the mean time to achieve renal complete response was 1.33 months.In the moderate reduction in eGFR group, the renal CR rates were 75.00%(6/8), 100.00%(5/5), 100.00%(2/2), and 100.00%(2/2) from the first to forth courses, respectively. In the severe reduction in eGFR group, the renal CR rates were 75.00%(9/12), 62.50%(5/8), 71.43%(5/7), and 66.67%(4/6) from the first to forth courses, respectively. In the renal failure or end-stage renal disease group, the renal CR rates were 50.00%(4/8), 62.50%(5/8), 85.71%(6/7), and 80.00%(4/5) from the first to forth courses, respectively.Median follow-up time of all patients was 14 months.Early death occurred in 5 patients(17.86%). There was no difference in OS between patients in different renal stage. The highest incidence of adverse events was lung infection, followed by neutropenia and thrombocytopenia. CONCLUSIONS:Bortezomib-based regimens had good short-term renal efficacy and safety in the treatment of MM patients with RI. Renal response bortezomib multiple myeloma renal impairment Figures Figure 1 Introduction Multiple myeloma (MM) is a hematologic malignancy of monoclonal plasma cells that accumulate in bone marrow,leading to bone destruction, marrow failure and other MM-related complications.Renal impairment (RI), that is defined as estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73m 2 , is seen in about 20%-50% of MM patients at diagnosis [ 1 – 3 ] . It’s reported that RI is associated with adverse outcomes and renal function recovery is associated with a significant increase in patient's overall survival [ 4 – 5 ] .Bortezomib, a first class of proteasome inhibitors, is now widely used in the treatment of MM since it was approved. The effect of bortezomib in MM patients with RI has been the subject of concent. Bortezomib-based regimens are currently the gold standard of the management of MM with RI [ 6 ] . Suboptimal bortezomib might contribute to poorer outcomes in MM patients with RI [ 3 ] .Nevertheless,we noticed that few studies have assessed the renal response and safety of bortezomib in the MM patients with RI. Therefore, we retrospectively analyzed the clinical data of 28 newly diagnosed MM patients with RI and evaluated the safety and renal efficacy of bortezomib in these patients at our institution in recent 4 years, aiming to formulate clinical treatment strategies and improve the renal recovery rate and prognosis in the MM patients with RI. Materials and methods Patients This single-center, retrospective study included newly diagnosed multiple myeloma(NDMM) patients with renal impairment at the Department of Hematology, the Second Hospital of Shandong University, between January 1, 2019, and December 31, 2022.The inclusion criterion were as follows: (1)the diagnosis met the relevant criteria in the International Myeloma Working Group (IMWG) criteria [ 7 ] ;(2)estimated glomerular filtration rate (eGFR) < 60ml/min/1.73m 2 prior to myeloma diagnosis,The eGFR was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation [ 8 , 9 ] ; (3)patients were newly diagnosed and not received any treatment for MM.(4) Enrolled patients received continuous bortezomib-based therapy, including the 28-day course of bortezomib (1.3 mg/m 2 subcutaneous on days 1, 4, 8, and 11).The exclusion criteria were as follows: (1) patients with a lack of important indicators, such as serum creatinine level, which could not be compared before and after treatment;(2)patients did not complete the bortezomib- based regimens. Clinical data collection For all included patients, basic personal information was collected from the medical record system of the Second Hospital of Shandong University, including sex, age, medical history,clinical manifestations, and laboratory examination data,including serum calcium, serum albumin, serum β2-microglobulin,serum lactate dehydrogenase, serum creatinine. In addition, bone marrow cytology, flow cytometry, karyotype analysis, fluorescence in situ hybridization examination were obtained at the time of diagnosis. The MM cases were staged according to the International Staging System(ISS), the revised International Staging System(R-ISS) for multiple myeloma. Patients were followed up till June 30,2023. The primary end point was 4-month(4-course) renal overall response (renal-ORR), including renal minor response, renal partial response, renal complete response according to the IMWG criteria for renal response to anti-myeloma treatment [ 6 ] .Overall survival (OS) was defined as the interval between MM diagnosis and death or last follow-up.Assessment of adverse events (AEs) was conducted in alignment with National Cancer Institute Common Ter minology Criteria for Adverse Events 5.0 [ 10 ] . This retrospective study conformed to the World Declaration of Helsinki and was reviewed and approved by the Ethics Committee of the Second Hospital of Shandong University (NO:KYLL-2021(KJ)P-0489).Due to the retrospective nature of the study, informed consent was waived. Assessment of renal function and renal response to therapy Renal function was assessed by deriving eGFR, based on the CKD-EPI equation.The patients with RI were staged according to the CKD classification [ 11 ] : moderate reduction in eGFR is defined as eGFR 30-59ml/min/1.73 m 2 ,severe reduction in eGFR is defined as eGFR 15-29ml/min/1.73 m 2 ,renal failure or end-stage renal disease is defined as eGFR < 15ml/min/1.73 m 2 or renal replacement therapy. The renal recovery was defined according to the IMWG criteria for renal response to anti-myeloma treatment [ 6 ] : complete response(CR) is defined as eGFR from < 50 ml/min/1.73 m 2 to ≥ 60ml/min/1.73 m 2 ,partial response(PR) is defined as eGFR from < 15ml/min/1.73 m 2 to 30-59ml/min/1.73 m 2 , minor response(MR) is defined as < 15 ml/min/1.73 m 2 to 15-29ml/min/1.73 m 2 or 15-29ml/min/1.73 m 2 to 30–59 ml/min/1.73 m 2 . Statistical analysis The characteristics of inpatients were presented as descriptive statistics, continuous data as mean (standard deviation) or median (interquartile range) as appropriate, and categorical variables as numbers (percentages). The chi-square test and Student’s t test were used for univariate analysis and data comparison between the groups. The Kaplan-Meier method was used to estimate OS. Statistical significance was taken at the ≤ 0.05 level. All statistical analyses were performed using SPSS 22.0 software for Windows. Results Patients and baseline disease characteristics A total of 28 newly diagnosed MM patients with RI were included in the study. The mean age was 62.86years (range: 44–77 years),with 14(50.00%) males and 14(50.00%) females. 17.86% of patients were > 70 years old. The mean eGFR was 24.40ml/min/1.73 m 2 (range: 2.41–57.15ml/min/1.73 m 2 ). There were 8 patients (28.57%) with eGFRs of 30–59 ml/min/1.73 m 2 , 12 patients (42.86%) with eGFRs of 15–29 ml/min/1.73 m 2 , and 8 patients (28.57%) with eGFR < 15 ml/min/1.73 m 2 , including 5 patients(17.86%) receiving dialysis with regular filters at the first diagnosis.There were no differences among the three groups with different renal impairment in age,sex,serum β2-microglobulin, serum albumin, serum calcium, serum lactate dehydrogenase, serum creatinine, proportion of plasma cell in bone marrow at the first diagnosis. According to the International Staging System(ISS) and Revised-International Staging System(R-ISS), 89.29% patients had ISS stage III disease and 39.27% patients had R-ISS stage III disease.There were no difference in ISS stage or R-ISS stage among the three groups with different renal impairment. The clinical characteristics of the patient population is demonstrated in Table 1. 28 patients received a total of 77 courses of bortezomib-based therapy, including bortezomib combined with dexamethasone (BD regimen),bortezomib combined with cyclophosphamide and dexamethasone (BCD regimen), bortezomib combined with thalidomide and dexamethasone (BTD regimen), bortezomib combined with lenalidomide and dexamethasone (BLD regimen). 87.01% regimens were three-drug combinations (i.e., BD plus a third agent). Table 1. Clinical characteristics of MM patients with RI Characteristic,n(%) ∕ mean (SD) Total Population (n=28) Moderate reduction in eGFR(n=8) Severe reduction in eGFR(n=12) Renal failure or end-stage renal disease(n=8) p value Age(years), mean (SD) 62.86(8.22) 64.88(6.77) 62.17(8.17) 61.88(10.18) 0.727 Sex(Male),No.of patients(%) 14(50.00) 3(37.50) 7(58.3) 4(50.00) 0.659 Serumβ2-MG level(mg/L), mean (SD) 11.90(6.85) 8.01(4.73) 12.34(5.24) 15.12(9.28) 0.109 Serum ALB (g/L), mean (SD) 33.63(7.56) 33.75(6.21) 35.32(8.59) 30.98(7.29) 0.469 Serum Ca (mmol/L), mean (SD) 2.58(0.55) 2.42(0.45) 2.91(0.52) 2.21(0.43) 0.120 Serum LDH(U/L), mean (SD) 269.22(379.33) 387.63(642.95) 199.56(90.56) 215.83(81.75) 0.570 Bone marrow plasma cell proportion(%),mean (SD) 31.18(21.32) 34.75(22.25) 33.37(24.26) 24.33(16.03) 0.573 Comorbidity Hypertension,No.of patients(%) 10(35.71) 3(37.50) 4(33.33) 3(37.50) 0.974 Diabetes mellitus,No.of patients(%) 4(14.29) 0(0.00) 3(25.00) 1(12.50) 0.290 renal amyloidosis,No.of patients(%) 1(3.57) 0(0.00) 0(0.00) 1(12.50) 0.274 Monoclonal immunoglobulin type Heavy chain 0.574 none,No.of patients(%) 9(32.14) 3(37.50) 3(25.00) 3(37.50) IgG,No.of patients(%) 13(46.43) 4(50.00) 7(58.33) 2(25.00) IgA,No.of patients(%) 6(21.43) 1(12.50) 2(16.67) 3(37.50) Light chain 0.659 Kappa,No.of patients(%) 14(50.00) 5(62.50) 5(41.67) 4(50.00) Lambda,No.of patients(%) 14(50.00) 3(37.50) 7(58.33) 4(50.00) ISS,No.of patients(%) 0.205 II 3(10.71) 2(25.00) 0(0.00) 1(12.50) III 25(89.29) 6(75.00) 12(100.00) 7(87.50) R-ISS,No.of patients(%) 0.751 II 17(60.71) 5(62.50) 8(66.67) 4(50.00) III 11(39.29) 3(37.50) 4(33.33) 4(50.00) High risk cytogenetics,No.of patients(%) 0.941 del7q 3(10.71) 1(12.50) 1(8.33) 1(12.50) t(4,14) 5(17.86) 1(12.50) 3(25.00) 1(12.50) Abbreviations: SD, standard deviation;β2-MG, β2 microglobulin; ALB, albumin;Ca, calcium; eGFR, estimated glomerular filtration rate; LDH, lactic dehydrogenase; ISS, International Staging System; R-ISS, Revised- International Staging System. Renal Response After the first course of treatment, renal recovery was achieved in 19(19/28) patients,including 15(53.57%) patients attaining complete response, 1(3.57%) patient attaining partial response, and 3(10.71%) patients attaining minor response. 21 patients completed 2 courses of bortezomib-based chemotherapy. Among the 16 patients who achieved renal recovery after the second course of treatment, 12(57.14%) patients attained complete response and 4(19.05%) patients attained partial response. 16 patients completed 3 courses of bortezomib-based chemotherapy. Among the 14 patients who achieved renal recovery after the third course of treatment, 8( 50%) patients attained complete response, 3(18.75%) patients attained partial response, and 1(6.25%) patient attained minor response.Only 13 patients completed 4 courses of bortezomib-based chemotherapy. Among the 10 patients who achieved renal recovery after the forth course of treatment, 7(53.85%) patients attained complete response and 3(23.08%) patients attained partial response.The cumulative renal responce rates were 67.86%, 76.19%, 75.00%, and 76.92% from the first to forth courses, respectively, and the mean time to achieve renal complete response was 1.33 months(Table 2). Table 2. renal response of multiple myeloma patients with renal impairment after 4 courses Couse No.of patients No.of patients achieved renal response(%) CR PR MR 1st couse 28 15(53.57%) 1(3.57%) 3(10.71%) 2nd couse 21 12(57.14%) 4(19.05%) 0(0.00%) 3rd couse 16 8(50.00%) 3(18.75%) 1(6.25%) 4th couse 13 7(53.85%) 3(23.08%) 0(0.00%) Abbreviations:CR, complete response; PR,partial response; MR,minor response. We then analyzed renal response of MM patients with RI in different stage.Among the 8 patients in the moderate reduction in eGFR group, the renal response rates were 75.00%(6/8), 100.00%(5/5), 100.00%(2/2), and 100.00%(2/2) from the first to forth courses, respectively. Among the 12 patients in the severe reduction in eGFR group, the renal response rates were 75.00%(9/12), 62.50%(5/8), 71.43%(5/7), and 66.67%(4/6) from the first to forth courses, respectively. Among the 8 patients in the renal failure or end-stage renal disease group, the renal response rates were 50.00%(4/8), 62.50%(5/8), 85.71%(6/7), and 80.00%(4/5) from the first to forth courses, respectively. (Table 3). Table 3. renal response of multiple myeloma patients with renal impairment in different stage Moderate reduction in eGFR Severe reduction in eGFR Renal failure or end-stage renal disease p value RR1% 75.00%(6/8) 75.00%(9/12) 50.00%(4/8) 0.585 RR2 % 100.00%(5/5) 62.50%(5/8) 62.50%(5/8) 0.401 RR3% 100.00%(2/2) 71.43%(5/7) 85.71%(6/7) 1.000 RR4% 100.00% (2/2) 66.67%(4/6) 80.00%(4/5) 1.000 Abbreviations:RR, renal response,RR=CR+PR+MR;RR1, renal response after 1 course of treatment; RR2, renal response after 2 courses of treatment; RR3, renal response after 3 courses of treatment; RR4, renal response after 4 courses of treatment. Survival Outcome Early death (within 2 months from treatment initiation) occurred in 5 patients(17.86%).Median follow-up time of all patients was 14 months.We analyzed the survival outcomes of patients undergoing bortezomib-based therapy among the subgroups divided by renal function and renal responce. Median OS in the moderate reduction in eGFR group, the severe reduction in eGFR group, the renal failure or end-stage renal disease group were 13.2(95% CI: 0.4-26.8) months, 14.7(95% CI: 5.88-23.5) months, 15.2(95% CI: 3.4-27.2) months, respectively.While,there was no difference in OS between patients with renal impairment in different stage(P=0.614) (Figure 1). Safety The highest incidence of hematological adverse events was neutropenia (14.29%), followed by thrombocytopenia (10.71%). The highest incidence of non-hematological adverse events was lung infection (25.00%), followed by peripheral neuritis(7.14%).In the moderate reduction in eGFR group,the highest incidence of adverse events was lung infection(25.00%), followed by peripheral neuritis(12.50%) and impaired liver function(12.50%).In the severe reduction in eGFR group, the highest incidence of adverse events was neutropenia (33.33%), followed by thrombocytopenia (25.00%) and lung infection (16.67%). In the renal failure or end-stage renal disease group, the highest incidence of adverse events was lung infection(37.50%), followed by deep vein thrombosis (12.50%).There was no statistically significant difference in the incidence of adverse events in patients with renal impairment in different stage(Table 4). Table 4. adverse events of multiple myeloma patients with renal impairment in different stage Moderate reduction in eGFR Severe reduction in eGFR Renal failure or end-stage renal disease p neutropenia 0.00% 33.33% 0.00% 0.045 thrombocytopenia 0.00% 25.00% 0.00% 0.106 lung infection 25.00% 16.67% 37.50% 1.00 acute pancreatitis 0.00% 8.33% 0.00% 0.501 deep vein thrombosis 0.00% 0.00% 12.50 0.274 cardiac discomfort 0.00% 8.33% 0.00% 0.501 peripheral neuritis 12.50% 8.33% 0.00% 0.610 pruritus 0.00% 8.33% 0.00% 0.501 impaired liver function 12.50% 0.00% 0.00% 0.274 urinary system infection 0.00% 8.33% 0.00% 0.501 Discussion RI in patients with MM was associated with poor prognosis.It’s reported that the median survival of patients with RI was significantly shorter than patients without RI [12] . The novel agents have played a significant role in the improvement of renal and survival outcomes [6] .Ludwig H’s study found that bortezomib-doxorubicin-dexamethasone (BDD) therapy induced a high rate of myeloma response(72%) and renal response(62%) in 68 MM patients with light chain-induced acute renal failure and glomerular filtration rate (GFR) less than 50 mL/min [13] .According to Bridoux F’s study [14] , 3-month renal responses of patients with RI received bortezomib plus dexamethasone (BD) therapy or BD plus cyclophosphamide (C-BD) therapy were 44.6% and 51.1%, respectively.However, patients with indication for hemodialysis and preexisting chronic kidney disease (CKD) with eGFR3 months were exclused in above study.A prospective study [15] demonstrates pomalidomide-bortezomib-dexamethasone (PVD) regimen could achieve a 3-month renal response of 75.4%,which was higher than most previous prospective studies. In this study, we retrospectively analyzed 28 patients with MM, including 8 patients with moderate reduction in eGFR,12 patients with severe reduction in eGFR,and 8 patients with renal failure or end-stage renal disease at the time of diagnosis of MM,including 5 patients who received hemodialysis during treatment.In the three groups, there were no significant differences in the age of onset, sex ratio, laboratory parameter，MM immunotype, ISS stage or R- ISS stage.92.86% patients provided a benefit of renal function after bortezomib-based therapy. The mean time to achieve renal complete response was 1.33 courses. Our study also demonstrated doublet or triplet bortezomib-based regimens could achieve an early renal response(at least MR, within the first month after initiation of therapy) of 67.86% and a 4-month renal response of 76.92%. As consistent with previous literature reports,the bortezomib-based therapy has played a significant role in the improvement of renal outcomes. Then the improvement of renal outcome may bring about an improvement in prognosis and quality of life according to previous studies.However,there was no significant difference in the renal complete response rate or renal recovery rate during the first 4 courses of bortezomib-based treatment among patients between the moderate reduction in eGFR group, the severe reduction in eGFR group, and the renal failure or end-stage renal disease group. In addition,there was no difference either in OS or incidence of adverse events between the three groups with bortezomib-based first-line treatment. These findings pointed out staging of renal impairment based on eGFR at the time of diagnosis was not a key factor affecting renal recovery or survival outcomes. Further analysis revealed that patients who achieved an early renal response achieved more often a 4-month renal complete renal response (78.95% vs. 33.33%, P=0.035). Considering that previous literature analysis has shown a positive correlation between renal function recovery and survival outcomes in MM patients with RI, early renal recovery should be achieved as much as possible. We analyzed factors that could be associated with early renal response and found that lower serum creatinine, escaping dialysis and preventive use of antiviral drugs could course a higher probability of early renal response (Table 5). Table 5. factors associated with the early renal response Characteristic,n(%) ∕ mean (SD) patients with the early renal response(n=19) patients without the early renal response(n=9) p value Age(years), mean (SD) 63.53(7.31) 61.44(10.22) 0.244 Sex(Male),No.of patients(%) 9(47.4) 5(55.6) 0.686 Serumβ2-MG level(mg/L), mean (SD) 11.61(5.63) 12.50(9.31) 0.378 Serum ALB (g/L), mean (SD) 33.61(7.65) 33.68(7.83) 0.890 Serum Ca (mmol/L), mean (SD) 2.74(0.56) 2.19(0.31) 0.053 Serum LDH(U/L), mean (SD) 306.2(467.76) 199.88(78.75) 0.234 Bone marrow plasma cell proportion(%),mean (SD) 32.90(22.81) 27.56(18.47) 0.525 Serum Cr (μmol/L),mean (SD) 280.00(190.15) 601.37(565.94) 0.000 eGFR (ml/min/1.73 m 2 ),mean (SD) 26.38(16.15) 20.22(18.85) 0.621 Comorbidity,No.of patients(%) 8(42.1) 5(55.6) 0.505 High risk cytogenetics,No.of patients(%) 7(36.8) 1(11.1) 0.159 requiring dialysis,No.of patients(%) 1(5.3) 4(44.4) 0.011 ISS,No.of patients(%) 0.207 II 3(15.8) 0(0.0) III 16(84.2) 9(100.0) R-ISS,No.of patients(%) 0.657 II 11(57.9) 6(66.7) III 8(42.1) 3(33.3) three-drug regimen,No.of patients(%) 16(84.2) 8(88.9) 0.741 Preventive use of antiviral drugs,No.of patients(%) 17(89.5) 5(55.6) 0.041 In summary, our findings pointed out that bortezomib-based regimen could cause rapid improvement in renal function in NDMM patients with RI, and the overall safety was good. But staging of renal impairment based on eGFR at the time of diagnosis was not a key factor affecting renal recovery or survival outcomes. Early renal response were associated with a higher probability of 4-month renal responses.Further analysis revealed that lower serum creatinine, escaping dialysis and preventive use of antiviral drugs could course a higher probability of early renal response. For MM patients with RI, it is necessary to initiate treatment with bortezomib-based regimen as soon as possible.However,the present study has some limitations. Further evaluation of the efficacy of novel drugs should be conducted through some large sample, prospective data in MM patients with RI. Declarations Ethical statement This study was approved by the ethics committee of the Second Hospital of Shandong University(NO:KYLL-2021(KJ)P-0489) and with the 1964 Helsinki Declaration (with amendments). The requirement for written informed consent was waived because this was an observational retrospective study. Consent for publication Not applicable. Funding This study was supported by 2021 Shandong Medical Association Clinical Research Fund -- Qilu Special Project(No. YXH2022ZX02059). Conflict of interest statement The authors declare no conflicts of interest that could appear to have influenced the submitted work. Data availability statement The data that support the findings of this study are available from the corresponding author upon reasonable request. References Laforet M, Jourde-Chiche N, Haddad F, Sallee M, Stoppa AM, Brunet P, Dussol B, Burtey S, Gondouin B. Evolution in the treatment of multiple myeloma and impact on dialysis independence: data from a French cohort from 1999 to 2014. Blood Cancer J. 2016 Mar 25;6(3):e409. doi: 10.1038/bcj.2016.17. PMID: 27015286; PMCID: PMC4817100. Yadav P, Cook M, Cockwell P. Current Trends of Renal Impairment in Multiple Myeloma. 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Eleutherakis-Papaiakovou V, Bamias A, Gika D, Simeonidis A, Pouli A, Anagnostopoulos A, Michali E, Economopoulos T, Zervas K, Dimopoulos MA; Greek Myeloma Study Group. Renal failure in multiple myeloma: incidence, correlations, and prognostic significance. Leuk Lymphoma. 2007 Feb;48(2):337-41. Ludwig, H, Adam, Z, Hajek, R, et al. Light chain-induced acute renal failure can be reversed by bortezomib-doxorubicin-dexamethasone in multiple myeloma: results of a phase II study. J CLIN ONCOL. 2010; 28 (30): 4635-41. doi: 10.1200/JCO.2010.28.1238. Bridoux, F, Arnulf, B, Karlin, L, et al. Randomized Trial Comparing Double Versus Triple Bortezomib-Based Regimen in Patients With Multiple Myeloma and Acute Kidney Injury Due to Cast Nephropathy. J CLIN ONCOL. 2020; 38 (23): 2647-2657. doi: 10.1200/JCO.20.00298. Jian, Y, Chang, L, Shi, MX, et al. Pomalidomide, bortezomib, and dexamethasone for newly diagnosed multiple myeloma patients with renal impairment. BLOOD ADV. 2023; 7 (24): 7581-7584. doi: 10.1182/bloodadvances.2023011428. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5961647","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":413332577,"identity":"fb2d0c4a-fb51-43d5-9984-c2376f3d2354","order_by":0,"name":"Chen CHEN","email":"","orcid":"","institution":"the Second Hospital of Shandong University","correspondingAuthor":false,"prefix":"","firstName":"Chen","middleName":"","lastName":"CHEN","suffix":""},{"id":413332578,"identity":"f4d5b2a6-4589-4051-890f-b692dd93a6fb","order_by":1,"name":"Yan DONG","email":"","orcid":"","institution":"the Second Hospital of Shandong University","correspondingAuthor":false,"prefix":"","firstName":"Yan","middleName":"","lastName":"DONG","suffix":""},{"id":413332579,"identity":"b4a3beba-f245-4b11-b838-ab16937ee065","order_by":2,"name":"Jian QI","email":"","orcid":"","institution":"the 960th Hospital of PLA","correspondingAuthor":false,"prefix":"","firstName":"Jian","middleName":"","lastName":"QI","suffix":""},{"id":413332581,"identity":"75c348ae-c8ed-4125-ada2-e3de1cd37502","order_by":3,"name":"Juandong WANG","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5UlEQVRIiWNgGAWjYBACxgYgwQPjfTCwkSNNC+OMgjRj4qyCaWHm+XA4kaBq5hnJzx68qbhjt+H42cOvbQyYExjYDx/dgNdhM9LMDeeceZa84UxemnWOAVseA09a2g38WhLMpHnbDiebHcgxM84x4ClmkOAxI6Al/RtEy/k3ZsYWBhKJDYS15IBtsTO7kWP8mMHAgAgtPW/KJOecOZxgf+ONGWOPQYIxGyG/GLanb5N4U3HYXrI/x/jDjz//5fjZDx/Dr6UBQicCaTYJEIsNn3IQkIfS9kDM/IGQ6lEwCkbBKBiZAABz6Uy1j7qWqQAAAABJRU5ErkJggg==","orcid":"","institution":"the Second Hospital of Shandong University","correspondingAuthor":true,"prefix":"","firstName":"Juandong","middleName":"","lastName":"WANG","suffix":""}],"badges":[],"createdAt":"2025-02-05 02:38:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5961647/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5961647/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":75898214,"identity":"1d9770c0-dc4d-466b-8022-5db035552d53","added_by":"auto","created_at":"2025-02-10 10:44:57","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":163871,"visible":true,"origin":"","legend":"\u003cp\u003eOverall Survival in multiple myeloma patients with renal impairment in different stage\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5961647/v1/46a94585469ad7ce50d593af.png"},{"id":75918331,"identity":"f67661fc-d212-4599-9376-fcdcaee744e6","added_by":"auto","created_at":"2025-02-10 14:02:16","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":872713,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5961647/v1/4434c847-2759-4200-894d-c7baa4b0e14b.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Renal response and safety in real world of bortezomib treatment in newly diagnosed multiple myeloma patients with renal impairment","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMultiple myeloma (MM) is a hematologic malignancy of monoclonal plasma cells that accumulate in bone marrow,leading to bone destruction, marrow failure and other MM-related complications.Renal impairment (RI), that is defined as estimated glomerular filtration rate (eGFR)\u0026thinsp;\u0026lt;\u0026thinsp;60 mL/min/1.73m\u003csup\u003e2\u003c/sup\u003e, is seen in about 20%-50% of MM patients at diagnosis\u003csup\u003e[\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. It\u0026rsquo;s reported that RI is associated with adverse outcomes and renal function recovery is associated with a significant increase in patient's overall survival\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e.Bortezomib, a first class of proteasome inhibitors, is now widely used in the treatment of MM since it was approved. The effect of bortezomib in MM patients with RI has been the subject of concent. Bortezomib-based regimens are currently the gold standard of the management of MM with RI\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. Suboptimal bortezomib might contribute to poorer outcomes in MM patients with RI\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e.Nevertheless,we noticed that few studies have assessed the renal response and safety of bortezomib in the MM patients with RI. Therefore, we retrospectively analyzed the clinical data of 28 newly diagnosed MM patients with RI and evaluated the safety and renal efficacy of bortezomib in these patients at our institution in recent 4 years, aiming to formulate clinical treatment strategies and improve the renal recovery rate and prognosis in the MM patients with RI.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003ePatients\u003c/p\u003e \u003cp\u003eThis single-center, retrospective study included newly diagnosed multiple myeloma(NDMM) patients with renal impairment at the Department of Hematology, the Second Hospital of Shandong University, between January 1, 2019, and December 31, 2022.The inclusion criterion were as follows: (1)the diagnosis met the relevant criteria in the International Myeloma Working Group (IMWG) criteria\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e;(2)estimated glomerular filtration rate (eGFR)\u0026thinsp;\u0026lt;\u0026thinsp;60ml/min/1.73m\u003csup\u003e2\u003c/sup\u003e prior to myeloma diagnosis,The eGFR was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e; (3)patients were newly diagnosed and not received any treatment for MM.(4) Enrolled patients received continuous bortezomib-based therapy, including the 28-day course of bortezomib (1.3 mg/m\u003csup\u003e2\u003c/sup\u003e subcutaneous on days 1, 4, 8, and 11).The exclusion criteria were as follows: (1) patients with a lack of important indicators, such as serum creatinine level, which could not be compared before and after treatment;(2)patients did not complete the bortezomib- based regimens.\u003c/p\u003e \u003cp\u003eClinical data collection\u003c/p\u003e \u003cp\u003eFor all included patients, basic personal information was collected from the medical record system of the Second Hospital of Shandong University, including sex, age, medical history,clinical manifestations, and laboratory examination data,including serum calcium, serum albumin, serum β2-microglobulin,serum lactate dehydrogenase, serum creatinine. In addition, bone marrow cytology, flow cytometry, karyotype analysis, fluorescence in situ hybridization examination were obtained at the time of diagnosis. The MM cases were staged according to the International Staging System(ISS), the revised International Staging System(R-ISS) for multiple myeloma. Patients were followed up till June 30,2023. The primary end point was 4-month(4-course) renal overall response (renal-ORR), including renal minor response, renal partial response, renal complete response according to the IMWG criteria for renal response to anti-myeloma treatment\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e.Overall survival (OS) was defined as the interval between MM diagnosis and death or last follow-up.Assessment of adverse events (AEs) was conducted in alignment with National Cancer Institute Common Ter minology Criteria for Adverse Events 5.0\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003e This retrospective study conformed to the World Declaration of Helsinki and was reviewed and approved by the Ethics Committee of the Second Hospital of Shandong University (NO:KYLL-2021(KJ)P-0489).Due to the retrospective nature of the study, informed consent was waived.\u003c/p\u003e \u003cp\u003eAssessment of renal function and renal response to therapy\u003c/p\u003e \u003cp\u003eRenal function was assessed by deriving eGFR, based on the CKD-EPI equation.The patients with RI were staged according to the CKD classification\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e: moderate reduction in eGFR is defined as eGFR 30-59ml/min/1.73 m\u003csup\u003e2\u003c/sup\u003e,severe reduction in eGFR is defined as eGFR 15-29ml/min/1.73 m\u003csup\u003e2\u003c/sup\u003e,renal failure or end-stage renal disease is defined as eGFR\u0026thinsp;\u0026lt;\u0026thinsp;15ml/min/1.73 m\u003csup\u003e2\u003c/sup\u003e or renal replacement therapy.\u003c/p\u003e \u003cp\u003eThe renal recovery was defined according to the IMWG criteria for renal response to anti-myeloma treatment\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e: complete response(CR) is defined as eGFR from \u0026lt;\u0026thinsp;50 ml/min/1.73 m\u003csup\u003e2\u003c/sup\u003e to \u0026ge;\u0026thinsp;60ml/min/1.73 m\u003csup\u003e2\u003c/sup\u003e,partial response(PR) is defined as eGFR from \u0026lt;\u0026thinsp;15ml/min/1.73 m\u003csup\u003e2\u003c/sup\u003e to 30-59ml/min/1.73 m\u003csup\u003e2\u003c/sup\u003e, minor response(MR) is defined as \u0026lt;\u0026thinsp;15 ml/min/1.73 m\u003csup\u003e2\u003c/sup\u003e to 15-29ml/min/1.73 m\u003csup\u003e2\u003c/sup\u003e or 15-29ml/min/1.73 m\u003csup\u003e2\u003c/sup\u003e to 30\u0026ndash;59 ml/min/1.73 m\u003csup\u003e2\u003c/sup\u003e.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eThe characteristics of inpatients were presented as descriptive statistics, continuous data as mean (standard deviation) or median (interquartile range) as appropriate, and categorical variables as numbers (percentages). The chi-square test and Student\u0026rsquo;s t test were used for univariate analysis and data comparison between the groups. The Kaplan-Meier method was used to estimate OS. Statistical significance was taken at the \u0026le;\u0026thinsp;0.05 level. All statistical analyses were performed using SPSS 22.0 software for Windows.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003ePatients and baseline disease characteristics\u003c/p\u003e \u003cp\u003eA total of 28 newly diagnosed MM patients with RI were included in the study. The mean age was 62.86years (range: 44\u0026ndash;77 years),with 14(50.00%) males and 14(50.00%) females. 17.86% of patients were \u0026gt;\u0026thinsp;70 years old. The mean eGFR was 24.40ml/min/1.73 m\u003csup\u003e2\u003c/sup\u003e (range: 2.41\u0026ndash;57.15ml/min/1.73 m\u003csup\u003e2\u003c/sup\u003e ). There were 8 patients (28.57%) with eGFRs of 30\u0026ndash;59 ml/min/1.73 m\u003csup\u003e2\u003c/sup\u003e, 12 patients (42.86%) with eGFRs of 15\u0026ndash;29 ml/min/1.73 m\u003csup\u003e2\u003c/sup\u003e, and 8 patients (28.57%) with eGFR\u0026thinsp;\u0026lt;\u0026thinsp;15 ml/min/1.73 m\u003csup\u003e2\u003c/sup\u003e, including 5 patients(17.86%) receiving dialysis with regular filters at the first diagnosis.There were no differences among the three groups with different renal impairment in age,sex,serum β2-microglobulin, serum albumin, serum calcium, serum lactate dehydrogenase, serum creatinine, proportion of plasma cell in bone marrow at the first diagnosis. According to the International Staging System(ISS) and Revised-International Staging System(R-ISS), 89.29% patients had ISS stage III disease and 39.27% patients had R-ISS stage III disease.There were no difference in ISS stage or R-ISS stage among the three groups with different renal impairment. The clinical characteristics of the patient population is demonstrated in Table\u0026nbsp;1.\u003c/p\u003e \u003cp\u003e28 patients received a total of 77 courses of bortezomib-based therapy, including bortezomib combined with dexamethasone (BD regimen),bortezomib combined with cyclophosphamide and dexamethasone (BCD regimen), bortezomib combined with thalidomide and dexamethasone (BTD regimen), bortezomib combined with lenalidomide and dexamethasone (BLD regimen). 87.01% regimens were three-drug combinations (i.e., BD plus a third agent).\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;1. Clinical characteristics of MM patients with RI\u003c/p\u003e\u003cdiv\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"723\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 179px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristic,n(%)\u003c/strong\u003e\u003cstrong\u003e∕\u003c/strong\u003e\u003cstrong\u003emean (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal Population (n=28)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModerate reduction in eGFR(n=8)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSevere reduction in eGFR(n=12)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRenal failure or end-stage renal disease(n=8)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 179px;\"\u003e\n \u003cp\u003eAge(years), mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e62.86(8.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e64.88(6.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e62.17(8.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e61.88(10.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e0.727\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 179px;\"\u003e\n \u003cp\u003eSex(Male),No.of patients(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e14(50.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e3(37.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e7(58.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e4(50.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e0.659\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 179px;\"\u003e\n \u003cp\u003eSerum\u0026beta;2-MG \u0026nbsp;level(mg/L), mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e11.90(6.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e8.01(4.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e12.34(5.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e15.12(9.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e0.109\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 179px;\"\u003e\n \u003cp\u003eSerum ALB (g/L), mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e33.63(7.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e33.75(6.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e35.32(8.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e30.98(7.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e0.469\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 179px;\"\u003e\n \u003cp\u003eSerum Ca (mmol/L), mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e2.58(0.55)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e2.42(0.45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e2.91(0.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e2.21(0.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e0.120\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 179px;\"\u003e\n \u003cp\u003eSerum LDH(U/L), mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e269.22(379.33)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e387.63(642.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e199.56(90.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e215.83(81.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e0.570\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 179px;\"\u003e\n \u003cp\u003eBone marrow plasma cell proportion(%),mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e31.18(21.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e34.75(22.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e33.37(24.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e24.33(16.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e0.573\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 179px;\"\u003e\n \u003cp\u003eComorbidity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 179px;\"\u003e\n \u003cp\u003eHypertension,No.of patients(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e10(35.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e3(37.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e4(33.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e3(37.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e0.974\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 179px;\"\u003e\n \u003cp\u003eDiabetes mellitus,No.of patients(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e4(14.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e0(0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e3(25.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e1(12.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e0.290\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 179px;\"\u003e\n \u003cp\u003erenal amyloidosis,No.of patients(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e1(3.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e0(0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e0(0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e1(12.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e0.274\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 179px;\"\u003e\n \u003cp\u003eMonoclonal immunoglobulin type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 179px;\"\u003e\n \u003cp\u003eHeavy chain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e0.574\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 179px;\"\u003e\n \u003cp\u003enone,No.of patients(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e9(32.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e3(37.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e3(25.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e3(37.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 179px;\"\u003e\n \u003cp\u003eIgG,No.of patients(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e13(46.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e4(50.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e7(58.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e2(25.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 179px;\"\u003e\n \u003cp\u003eIgA,No.of patients(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e6(21.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e1(12.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e2(16.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e3(37.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 179px;\"\u003e\n \u003cp\u003eLight chain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e0.659\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 179px;\"\u003e\n \u003cp\u003eKappa,No.of patients(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e14(50.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e5(62.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e5(41.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e4(50.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 179px;\"\u003e\n \u003cp\u003eLambda,No.of patients(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e14(50.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e3(37.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e7(58.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e4(50.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 179px;\"\u003e\n \u003cp\u003eISS,No.of patients(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e0.205\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 179px;\"\u003e\n \u003cp\u003eII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e3(10.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e2(25.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e0(0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e1(12.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 179px;\"\u003e\n \u003cp\u003eIII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e25(89.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e6(75.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e12(100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e7(87.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 179px;\"\u003e\n \u003cp\u003eR-ISS,No.of patients(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e0.751\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 179px;\"\u003e\n \u003cp\u003eII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e17(60.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e5(62.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e8(66.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e4(50.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 179px;\"\u003e\n \u003cp\u003eIII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e11(39.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e3(37.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e4(33.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e4(50.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 179px;\"\u003e\n \u003cp\u003eHigh risk cytogenetics,No.of patients(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e0.941\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 179px;\"\u003e\n \u003cp\u003edel7q\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e3(10.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e1(12.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e1(8.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e1(12.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 179px;\"\u003e\n \u003cp\u003et(4,14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e5(17.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e1(12.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e3(25.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e1(12.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eAbbreviations: SD, standard deviation;\u0026beta;2-MG, \u0026beta;2 microglobulin; ALB, albumin;Ca, calcium; eGFR, estimated glomerular filtration rate; LDH, lactic dehydrogenase; ISS, International Staging System; R-ISS, Revised- International Staging System.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRenal Response \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAfter the first course of treatment, renal recovery was achieved in 19(19/28) patients,including 15(53.57%) patients attaining complete response, 1(3.57%) patient attaining partial response, and 3(10.71%) patients \u0026nbsp;attaining minor response. 21 patients completed 2 courses of bortezomib-based chemotherapy. Among the 16 patients who achieved renal recovery after the second course of treatment, 12(57.14%) patients attained complete response and 4(19.05%) patients attained partial response. 16 patients completed 3 courses of bortezomib-based chemotherapy. Among the 14 patients who achieved renal recovery after the third course of treatment, 8( 50%) patients attained complete response, 3(18.75%) patients \u0026nbsp;attained partial response, and 1(6.25%) patient \u0026nbsp;attained minor response.Only 13 patients completed 4 courses of bortezomib-based chemotherapy. Among the 10 patients who achieved renal recovery after the forth course of treatment, 7(53.85%) patients attained complete response and 3(23.08%) patients attained partial response.The cumulative renal responce rates were 67.86%, 76.19%, 75.00%, and 76.92% from the first to forth courses, respectively, and the mean time to achieve renal complete response was 1.33 months(Table 2).\u003c/p\u003e\n\u003cp\u003eTable 2. renal response of multiple myeloma patients with renal impairment after 4 courses\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"568\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 111px;\"\u003e\n \u003cp\u003eCouse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003eNo.of patients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 344px;\"\u003e\n \u003cp\u003eNo.of patients achieved renal response(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003eCR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003ePR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003eMR\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e1st couse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e15(53.57%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e1(3.57%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e3(10.71%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e2nd couse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e12(57.14%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e4(19.05%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0(0.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e3rd couse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e8(50.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e3(18.75%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e1(6.25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e4th couse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e7(53.85%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e3(23.08%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0(0.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eAbbreviations:CR, complete response; PR,partial response; MR,minor response.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe then analyzed renal response of MM patients with RI in different stage.Among the 8 patients in the moderate reduction in eGFR group, the renal response rates were 75.00%(6/8), 100.00%(5/5), 100.00%(2/2), and 100.00%(2/2) from the first to forth courses, respectively. Among the 12 patients in the severe reduction in eGFR group, the renal response rates were 75.00%(9/12), 62.50%(5/8), 71.43%(5/7), and 66.67%(4/6) from the first to forth courses, respectively. Among the 8 patients in the renal failure or end-stage renal disease group, the renal response rates were 50.00%(4/8), 62.50%(5/8), 85.71%(6/7), and 80.00%(4/5) from the first to forth courses, respectively. (Table 3).\u003c/p\u003e\n\u003cp\u003eTable 3. renal response of multiple myeloma patients with renal impairment in different stage\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"705\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModerate reduction in eGFR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSevere reduction in eGFR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRenal failure or end-stage renal disease\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eRR1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e75.00%(6/8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e75.00%(9/12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003e50.00%(4/8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e0.585\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eRR2 %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e100.00%(5/5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e62.50%(5/8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003e62.50%(5/8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e0.401\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eRR3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e100.00%(2/2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e71.43%(5/7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003e85.71%(6/7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eRR4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e100.00% (2/2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e66.67%(4/6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003e80.00%(4/5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eAbbreviations:RR, renal response,RR=CR+PR+MR;RR1, renal response after 1 course of treatment; RR2, renal response after 2 courses of treatment; RR3, renal response after 3 courses of treatment; RR4, renal response after 4 courses of treatment.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSurvival Outcome\u003c/p\u003e\n\u003cp\u003eEarly death (within 2 months from treatment initiation) occurred in 5 \u0026nbsp; patients(17.86%).Median follow-up time of all patients was 14 months.We analyzed the survival outcomes of patients undergoing \u0026nbsp;bortezomib-based therapy among the subgroups divided by renal function and renal responce. Median OS in the moderate reduction in eGFR group, the severe reduction in eGFR group, the renal failure or end-stage renal disease group were 13.2(95% CI: 0.4-26.8) months, 14.7(95% CI: 5.88-23.5) months, 15.2(95% CI: 3.4-27.2) months, respectively.While,there was no difference in OS between patients with renal impairment in different stage(P=0.614) (Figure 1).\u003c/p\u003e\u003cp\u003eSafety\u003c/p\u003e\n\u003cp\u003eThe highest incidence of hematological adverse events was neutropenia (14.29%), followed by thrombocytopenia (10.71%). The highest incidence of non-hematological adverse events was lung infection (25.00%), followed by peripheral neuritis(7.14%).In the moderate reduction in eGFR group,the highest incidence of adverse events was lung infection(25.00%), followed by peripheral neuritis(12.50%) and \u0026nbsp;impaired liver function(12.50%).In the severe reduction in eGFR group, the highest incidence of adverse events was neutropenia (33.33%), followed by thrombocytopenia (25.00%) and lung infection (16.67%). In the renal failure or end-stage renal disease group, the highest incidence of adverse events was lung infection(37.50%), followed by deep vein thrombosis (12.50%).There was no statistically significant difference in the incidence of adverse events in patients with renal impairment in different stage(Table 4).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 4. adverse events of multiple myeloma patients with renal impairment in different stage\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"617\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 134px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModerate reduction in eGFR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSevere reduction in eGFR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 167px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRenal failure or end-stage renal disease\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 134px;\"\u003e\n \u003cp\u003eneutropenia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e0.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e33.33%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 167px;\"\u003e\n \u003cp\u003e0.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.045\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 134px;\"\u003e\n \u003cp\u003ethrombocytopenia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e0.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e25.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 167px;\"\u003e\n \u003cp\u003e0.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.106\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 134px;\"\u003e\n \u003cp\u003elung infection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e25.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e16.67%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 167px;\"\u003e\n \u003cp\u003e37.50%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 134px;\"\u003e\n \u003cp\u003eacute pancreatitis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e0.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e8.33%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 167px;\"\u003e\n \u003cp\u003e0.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.501\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 134px;\"\u003e\n \u003cp\u003edeep vein thrombosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e0.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e0.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 167px;\"\u003e\n \u003cp\u003e12.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.274\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 134px;\"\u003e\n \u003cp\u003ecardiac discomfort\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e0.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e8.33%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 167px;\"\u003e\n \u003cp\u003e0.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.501\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 134px;\"\u003e\n \u003cp\u003eperipheral neuritis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e12.50%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e8.33%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 167px;\"\u003e\n \u003cp\u003e0.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.610\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 134px;\"\u003e\n \u003cp\u003epruritus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e0.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e8.33%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 167px;\"\u003e\n \u003cp\u003e0.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.501\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 134px;\"\u003e\n \u003cp\u003eimpaired\u0026nbsp;liver\u0026nbsp;function\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e12.50%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e0.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 167px;\"\u003e\n \u003cp\u003e0.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.274\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 134px;\"\u003e\n \u003cp\u003eurinary system infection\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e0.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e8.33%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 167px;\"\u003e\n \u003cp\u003e0.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.501\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eRI in patients with MM was associated with poor prognosis.It\u0026rsquo;s reported that the median survival of patients with RI was significantly shorter\u0026nbsp;than patients without RI\u003csup\u003e[12]\u003c/sup\u003e.\u0026nbsp;The novel agents have played a significant role in the improvement of renal and survival outcomes\u003csup\u003e[6]\u003c/sup\u003e.Ludwig H\u0026rsquo;s study found that bortezomib-doxorubicin-dexamethasone (BDD) therapy induced a high rate of myeloma response(72%) and renal response(62%) in 68 MM patients with light chain-induced acute renal failure and glomerular filtration rate (GFR) less than 50 mL/min \u003csup\u003e[13]\u003c/sup\u003e.According to Bridoux F\u0026rsquo;s study\u003csup\u003e[14]\u003c/sup\u003e, 3-month renal responses of patients with RI received bortezomib plus dexamethasone (BD) therapy or BD plus cyclophosphamide (C-BD) therapy were 44.6% and 51.1%, respectively.However, patients with indication for hemodialysis and preexisting chronic kidney disease (CKD) with eGFR\u0026lt;30 mL/min/1.73 m\u003csup\u003e2\u003c/sup\u003e for\u0026gt;3 months were exclused in above study.A prospective study\u003csup\u003e[15]\u003c/sup\u003e demonstrates pomalidomide-bortezomib-dexamethasone (PVD) \u0026nbsp;regimen could achieve a 3-month renal response of 75.4%,which was higher than most previous prospective studies. In this study, we retrospectively analyzed 28 patients with MM, including 8 patients with moderate reduction in eGFR,12 patients with severe reduction in eGFR,and 8 patients with renal failure or end-stage renal disease at the time of diagnosis of MM,including 5 patients who received hemodialysis during treatment.In the three groups, there were no significant differences in the age of onset, sex ratio, laboratory parameter，MM immunotype, ISS stage or R- ISS stage.92.86% patients provided a benefit of renal function after bortezomib-based therapy. The mean time to achieve renal complete response was 1.33 courses. Our study also demonstrated doublet or triplet bortezomib-based regimens could achieve an early renal response(at least MR, within the first month after initiation of therapy) of 67.86% and a 4-month renal response of 76.92%. As consistent with previous literature reports,the bortezomib-based therapy has played a significant role in the improvement of renal outcomes. Then the improvement of renal outcome \u0026nbsp;may bring about an improvement in prognosis and quality of life according to previous studies.However,there was no significant difference in the renal complete response rate or renal recovery rate during the first 4 courses of bortezomib-based treatment among patients between the moderate reduction in eGFR group, the severe reduction in eGFR group, and the renal failure or end-stage renal disease group. In addition,there was no difference either in OS or incidence of adverse events between the three groups with bortezomib-based first-line treatment. These findings pointed out staging of renal impairment based on eGFR at the time of diagnosis was not a key factor affecting renal recovery or survival outcomes.\u003c/p\u003e\n\u003cp\u003eFurther analysis revealed that patients who achieved an early renal response achieved more often a 4-month renal complete renal response (78.95% vs. 33.33%, P=0.035).\u0026nbsp;Considering that previous literature analysis has shown a positive correlation between renal function recovery and survival outcomes in MM patients with RI, early renal recovery should be achieved as much as possible.\u0026nbsp;We analyzed factors that could be associated with early renal response and found that lower serum creatinine, escaping dialysis and preventive use of antiviral drugs could course a higher probability of early renal response (Table 5).\u003c/p\u003e\n\u003cp\u003eTable 5. factors associated with the early renal response\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"690\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristic,n(%)\u003c/strong\u003e\u003cstrong\u003e∕\u003c/strong\u003e\u003cstrong\u003emean (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003epatients with \u0026nbsp; \u0026nbsp; the early renal response(n=19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003epatients without the early renal response(n=9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003ep value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003eAge(years), mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003e63.53(7.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e61.44(10.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e0.244\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003eSex(Male),No.of patients(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003e9(47.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e5(55.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e0.686\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003eSerum\u0026beta;2-MG \u0026nbsp; \u0026nbsp; level(mg/L), mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003e11.61(5.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e12.50(9.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e0.378\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003eSerum ALB (g/L), mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003e33.61(7.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e33.68(7.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e0.890\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003eSerum Ca (mmol/L), mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003e2.74(0.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e2.19(0.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e0.053\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003eSerum LDH(U/L), mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003e306.2(467.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e199.88(78.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e0.234\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003eBone marrow plasma cell proportion(%),mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003e32.90(22.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e27.56(18.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e0.525\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003eSerum Cr (\u0026mu;mol/L),mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003e280.00(190.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e601.37(565.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e0.000\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003eeGFR (ml/min/1.73 m\u003csup\u003e2\u003c/sup\u003e),mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003e26.38(16.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e20.22(18.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e0.621\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003eComorbidity,No.of patients(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003e8(42.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e5(55.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e0.505\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003eHigh risk cytogenetics,No.of patients(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003e7(36.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e1(11.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e0.159\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003erequiring dialysis,No.of patients(%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003e1(5.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e4(44.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e0.011\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003eISS,No.of patients(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e0.207\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003eII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003e3(15.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003eIII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003e16(84.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e9(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003eR-ISS,No.of patients(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e0.657\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003eII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003e11(57.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e6(66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003eIII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003e8(42.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e3(33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003ethree-drug regimen,No.of patients(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003e16(84.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e8(88.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e0.741\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003ePreventive use of antiviral drugs,No.of patients(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003e17(89.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e5(55.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e0.041\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eIn summary, our findings pointed out that bortezomib-based regimen could cause rapid improvement in renal function in NDMM patients with RI, and the overall safety was good. But staging of renal impairment based on eGFR at the time of diagnosis was not a key factor affecting renal recovery or survival outcomes. Early renal response were associated with a higher probability of 4-month renal responses.Further analysis revealed that lower serum creatinine, escaping dialysis and preventive use of antiviral drugs could course a higher probability of early renal response. For MM patients with RI, it is necessary to initiate treatment with bortezomib-based regimen as soon as possible.However,the present study has some limitations. Further evaluation of the efficacy of novel drugs should be conducted through some large sample, prospective data in MM patients with RI.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthical statement\u003c/p\u003e\n\u003cp\u003eThis study was approved by the ethics committee of the Second Hospital of Shandong University(NO:KYLL-2021(KJ)P-0489) and with the 1964 Helsinki Declaration (with amendments). The requirement for written informed consent was waived because this was an observational retrospective study.\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThis study was supported by 2021 Shandong Medical Association Clinical Research Fund -- Qilu Special Project(No. YXH2022ZX02059).\u003c/p\u003e\n\u003cp\u003eConflict of interest statement\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflicts of interest that could appear to have influenced the submitted work.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eData availability statement \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eLaforet M, Jourde-Chiche N, Haddad F, Sallee M, Stoppa AM, Brunet P, Dussol B, Burtey S, Gondouin B. Evolution in the treatment of multiple myeloma and impact on dialysis independence: data from a French cohort from 1999 to 2014. Blood Cancer J. 2016 Mar 25;6(3):e409. doi: 10.1038/bcj.2016.17. PMID: 27015286; PMCID: PMC4817100.\u003c/li\u003e\n\u003cli\u003eYadav P, Cook M, Cockwell P. Current Trends of Renal Impairment in Multiple Myeloma. Kidney Dis (Basel). 2016 Mar;1(4):241-57. doi: 10.1159/000442511. Epub 2016 Feb 3. PMID: 27536684; PMCID: PMC4934811.\u003c/li\u003e\n\u003cli\u003eHo PJ, Moore EM, McQuilten ZK, Wellard C, Bergin K, Augustson B, Blacklock H, Harrison SJ, Horvath N, King T, Mollee P, Quach H, Reid C, Rosengarten B, Walker P, Wood EM, Spencer A. Renal Impairment at Diagnosis in Myeloma: Patient Characteristics, Treatment, and Impact on Outcomes. Results From the Australia and New Zealand Myeloma and Related Diseases Registry. Clin Lymphoma Myeloma Leuk. 2019 Aug;19(8):e415-e424. doi: 10.1016/j.clml.2019.05.010. Epub 2019 May 16. PMID: 31208889.\u003c/li\u003e\n\u003cli\u003eKnudsen LM, Hjorth M, Hippe E. Renal failure in multiple myeloma: reversibility and impact on the prognosis. Nordic Myeloma Study Group. Eur J Haematol. 2000 Sep;65(3):175-81. doi: 10.1034/j.1600-0609.2000.90221.x. PMID: 11007053.\u003c/li\u003e\n\u003cli\u003eLi S, Zhang M, Liu J, Liu S, Zhu C, Shang D, Guan Y, Wang Q. Risk nomogram for assessing renal recovery in patients with newly diagnosed multiple myeloma-related renal impairment. Curr Probl Cancer. 2023 Aug;47(4):100962. doi: 10.1016/j.currproblcancer.2023.100962. Epub 2023 May 23. PMID: 37247442.\u003c/li\u003e\n\u003cli\u003eDimopoulos MA, Merlini G, Bridoux F, Leung N, Mikhael J, Harrison SJ, Kastritis E, Garderet L, Gozzetti A, van de Donk NWCJ, Weisel KC, Badros AZ, Beksac M, Hillengass J, Mohty M, Ho PJ, Ntanasis-Stathopoulos I, Mateos MV, Richardson P, Blade J, Moreau P, San-Miguel J, Munshi N, Rajkumar SV, Durie BGM, Ludwig H, Terpos E; International Myeloma Working Group. Management of multiple myeloma-related renal impairment: recommendations from the International Myeloma Working Group. Lancet Oncol. 2023 Jul;24(7):e293-e311. doi: 10.1016/S1470-2045(23)00223-1. PMID: 37414019.\u003c/li\u003e\n\u003cli\u003eRajkumar SV, Dimopoulos MA, Palumbo A, Blade J, Merlini G, Mateos MV, Kumar S, Hillengass J, Kastritis E, Richardson P, Landgren O, Paiva B, Dispenzieri A, Weiss B, LeLeu X, Zweegman S, Lonial S, Rosinol L, Zamagni E, Jagannath S, Sezer O, Kristinsson SY, Caers J, Usmani SZ, Lahuerta JJ, Johnsen HE, Beksac M, Cavo M, Goldschmidt H, Terpos E, Kyle RA, Anderson KC, Durie BG, Miguel JF. International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma. Lancet Oncol. 2014 Nov;15(12):e538-48. doi: 10.1016/S1470-2045(14)70442-5. Epub 2014 Oct 26. PMID: 25439696.\u003c/li\u003e\n\u003cli\u003eLevey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, Kusek JW, Eggers P, Van Lente F, Greene T, Coresh J; CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration). A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009 May 5;150(9):604-12. doi: 10.7326/0003-4819-150-9-200905050-00006. Erratum in: Ann Intern Med. 2011 Sep 20;155(6):408. PMID: 19414839; PMCID: PMC2763564.\u003c/li\u003e\n\u003cli\u003ePalevsky PM, Liu KD, Brophy PD, Chawla LS, Parikh CR, Thakar CV, Tolwani AJ, Waikar SS, Weisbord SD. KDOQI US commentary on the 2012 KDIGO clinical practice guideline for acute kidney injury. Am J Kidney Dis. 2013 May;61(5):649-72. doi: 10.1053/j.ajkd.2013.02.349. Epub 2013 Mar 15. PMID: 23499048.\u003c/li\u003e\n\u003cli\u003eCommon Terminology Criteria for Adverse Events (CTCAE) Version 5. Published: November 27. USDEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Cancer Institute.\u003c/li\u003e\n\u003cli\u003eLevey AS, Eckardt KU, Tsukamoto Y, Levin A, Coresh J, Rossert J, De Zeeuw D, Hostetter TH, Lameire N, Eknoyan G. Definition and classification of chronic kidney disease: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int. 2005 Jun;67(6):2089-100. doi: 10.1111/j.1523-1755.2005.00365.x. PMID: 15882252.\u003c/li\u003e\n\u003cli\u003eEleutherakis-Papaiakovou V, Bamias A, Gika D, Simeonidis A, Pouli A, Anagnostopoulos A, Michali E, Economopoulos T, Zervas K, Dimopoulos MA; Greek Myeloma Study Group. Renal failure in multiple myeloma: incidence, correlations, and prognostic significance. Leuk Lymphoma. 2007 Feb;48(2):337-41. \u003c/li\u003e\n\u003cli\u003eLudwig, H, Adam, Z, Hajek, R, et al. Light chain-induced acute renal failure can be reversed by bortezomib-doxorubicin-dexamethasone in multiple myeloma: results of a phase II study. J CLIN ONCOL. 2010; 28 (30): 4635-41. doi: 10.1200/JCO.2010.28.1238.\u003c/li\u003e\n\u003cli\u003eBridoux, F, Arnulf, B, Karlin, L, et al. Randomized Trial Comparing Double Versus Triple Bortezomib-Based Regimen in Patients With Multiple Myeloma and Acute Kidney Injury Due to Cast Nephropathy. J CLIN ONCOL. 2020; 38 (23): 2647-2657. doi: 10.1200/JCO.20.00298.\u003c/li\u003e\n\u003cli\u003eJian, Y, Chang, L, Shi, MX, et al. Pomalidomide, bortezomib, and dexamethasone for newly diagnosed multiple myeloma patients with renal impairment. BLOOD ADV. 2023; 7 (24): 7581-7584. doi: 10.1182/bloodadvances.2023011428.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Renal response, bortezomib, multiple myeloma, renal impairment","lastPublishedDoi":"10.21203/rs.3.rs-5961647/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5961647/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eAIMS:\u003cstrong\u003e \u003c/strong\u003eOur objective was to explore the renal efficacy and safety of bortezomib-based treatment in newly diagnosed multiple myeloma (NDMM) patients with Renal impairment (RI).\u003c/p\u003e\n\u003cp\u003eMETHODS: We retrospective evaluated NDMM patients with RI at the Second Hospital of Shandong University between between January 2019 and December 2022.RI was defined as having a estimated glomerular filtration rate (eGFR) \u0026lt; 60 mL/min/1.73 m\u003csup\u003e2\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eRESULTS: There were 28 patients inclused, and the mean eGFR was 24.40mL/min/1.73 m\u003csup\u003e2\u003c/sup\u003e. All patients received a total of 77 courses of bortezomib-based therapy, and 87.01% regimens were three-drug combinations. The renal responce rates were 67.86%, 76.19%, 75.00%, and 76.92% from the first to forth courses, respectively, and the mean time to achieve renal complete response was 1.33 months.In the moderate reduction in eGFR group, the renal CR rates were 75.00%(6/8), 100.00%(5/5), 100.00%(2/2), and 100.00%(2/2) from the first to forth courses, respectively. In the severe reduction in eGFR group, the renal CR rates were 75.00%(9/12), 62.50%(5/8), 71.43%(5/7), and 66.67%(4/6) from the first to forth courses, respectively. In the renal failure or end-stage renal disease group, the renal CR rates were 50.00%(4/8), 62.50%(5/8), 85.71%(6/7), and 80.00%(4/5) from the first to forth courses, respectively.Median follow-up time of all patients was 14 months.Early death occurred in 5 patients(17.86%). There was no difference in OS between patients in different renal stage. The highest incidence of adverse events was lung infection, followed by neutropenia and thrombocytopenia.\u003c/p\u003e\n\u003cp\u003eCONCLUSIONS:Bortezomib-based regimens had good short-term renal efficacy and safety in the treatment of MM patients with RI.\u003c/p\u003e","manuscriptTitle":"Renal response and safety in real world of bortezomib treatment in newly diagnosed multiple myeloma patients with renal impairment","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-02-10 10:44:52","doi":"10.21203/rs.3.rs-5961647/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8f29c537-9eb9-4c20-b136-61b1caf5e9cb","owner":[],"postedDate":"February 10th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-02-10T13:54:01+00:00","versionOfRecord":[],"versionCreatedAt":"2025-02-10 10:44:52","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5961647","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5961647","identity":"rs-5961647","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}