Terapevticheskii arkhivTerapevticheskii arkhiv0040-36602309-5342LLC Obyedinennaya Redaktsiya4312610.26442/00403660.2020.07.000777Research ArticleAutologous haematopoietic stem cell transplantation in patients with multiple myeloma complicated by dialysis-dependent renal failureFirsovaM. V.firs-maia@yandex.ruhttps://orcid.org/0000-0003-4142-171XMendeleevaL. P.firs-maia@yandex.ruhttps://orcid.org/0000-0002-4966-8146SolovevM. V.firs-maia@yandex.ruhttps://orcid.org/0000-0002-7944-6202RekhtinaI. G.firs-maia@yandex.ruhttps://orcid.org/0000-0001-5440-4340PokrovskayaO. S.firs-maia@yandex.ruhttps://orcid.org/0000-0002-8657-4990UrnovaE. S.firs-maia@yandex.ruhttps://orcid.org/0000-0002-2206-6532SobolevaN. P.firs-maia@yandex.ruhttps://orcid.org/0000-0002-1903-2446DvirnykV. N.firs-maia@yandex.ruhttps://orcid.org/0000-0002-9877-0796KlyasovaG. A.firs-maia@yandex.ruhttps://orcid.org/0000-0001-5973-5763KuzminaL. A.firs-maia@yandex.ruhttps://orcid.org/0000-0001-6201-6276SavchenkoV. G.firs-maia@yandex.ruhttps://orcid.org/0000-0001-8188-5557National Research Center for Hematology01092020927707625082020Copyright © 2020, Consilium Medicum2020<p><strong>Aim.</strong>To assess the safety and efficacy of autologous haematopoietic stem cell transplantation (auto-HSCT) in multiple myeloma (MM) patients with dialysis-dependent renal failure.</p>
<p><strong>Materials and methods.</strong>During a period from May 2010 to December 2016 fourteen MM patients with dialysis-dependent renal failure aged 48 to 65 years underwent auto-HSCT. After the induction therapy complete response, very good partial response, partial response were documented in 64, 29, 7% of patients, respectively. In no case was a renal response achieved. Haematopoietic stem cell mobilization in most patients (13/14) was performed according to the scheme: G-CSF 10 g/kg. Melphalan in 3 dosages was used as pre-transplant conditioning: 100, 140 and 200 mg/m<sup>2</sup>; 13 patients underwent a single and in one case underwent a tandem auto-HSCT against the background of hemodialysis. Evaluation of the antitumor and renal response was assessed on the 100th day after auto-HSCT. Subsequently, against the background of programmed hemodialysis and in the setting of high-dosed melphalan (100200 mg/m<sup>2</sup>), 13 patients underwent a single and one patient underwent a tandem auto-HSCT. At +100 days after auto-HSCT, an antitumor response and renal response were assessed.</p>
<p><strong>Results.</strong>The period of agranulocytosis after auto-HSCT was from 5 to 12 days (median 8,5) and was accompanied by infectious complications, cardiac and neurological dysfunctions. At +100 days after auto-HSCT, the complete response was confirmed in 71% patients and very good partial response was confirmed in 29% patients. The minimal renal response was registered in 2 patients (14%), hemodialysis was stopped. The transplant-related mortality was absent. After a median follow-up of 53 months 5-year progression-free survival was 59%, and overall survival was 93%.</p>
<p><strong>Conclusion.</strong>Carrying out auto-HSCT in patients with dialysis-dependent renal failure contributed to the achievement of a minimal renal response in 14% of cases, which allowed these patients to stop hemodialysis. Patients whose conditioning regimen was performed using melphalan at a dose of 200 mg/m<sup>2</sup>showed more frequent complications in the early post-transplant period compared to patients who received a lower dose of melphalan (100140 mg/m<sup>2</sup>). Auto-HSCT in MM patients with dialysis-dependent renal failure is a feasible and effective treatment method, which in some cases contributes to independence from hemodialysis.</p>multiple myelomaautologous haematopoietic stem cell transplantationacute kidney injurydialysis-dependent renal failureмножественная миеломатрансплантация аутологичных стволовых клеток кровиострое повреждение почекдиализ-зависимая почечная недостаточность[Dimopoulos MA, Sonneveld P, Leung N, et al. 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