[Clinical characteristics and prognosis of multiple myeloma patients treated with hemodialysis: a single center study].

Objective: To investigate the clinical characteristics and prognosis of multiple myeloma (MM) patients undergoing hemodialysis (HD). Methods: All MM patients initiating HD between Jan 1 st, 2008 and Oct 31 st, 2015 at Kidney Disease Center of the First Affiliated Hospital of Zhejiang University with complete data ( n =96) were enrolled. Age, initiating HD time and vascular access matched non-MM patients receiving HD were selected as the control group, and the ratio was 1∶2 ( n =192). Chi-squared analysis was used for unadjusted comparisons and logistic regression was used for adjusted comparisons between patients with and without MM. Kaplan-Meier analysis and log-rank test were applied to compare survival of patients. Cox proportional hazards regression was used to analyze prognostic factors for patients with MM after HD. Results: Compared to the control group, MM patients had higher percentage of coronary heart disease, pulmonary infection, and serum calcium, lower percentage of diabetes, lower hemoglobin and platelet ( P <0.05). The median follow-up time was 488 (212-1 064) days. At the end of the study, 68.8% (66/96) patients in the MM group died, 26.0% (25/96) patients survived, and no patients (0/96) switched to transplantation; in the non-MM group, the above-mentioned percentage was 16.7% (32/192), 70.8% (136/192), 6.3% (12/192), respectively. Kaplan-Meier analysis showed that MM patients had significantly lower survival rate ( P <0.01). In the MM group, the median total survival time was 205 days, and the median survival time for patients with hematologic complete remission (CR), partial remission (PR) and below PR (three subgroups) was 1 115, 417, 124 days, respectively. Kaplan-Meier analysis showed that the difference of cumulative survival rate of three subgroup was statistically significant ( P <0.01). Four factors were found to be correlated with survival rate of MM patients required HD using Cox multivariate regression model: age≥70 years ( HR =1.98, P =0.03), use of catheter ( HR =3.24, P =0.02), low albumin ( HR =2.31, P =0.04), and below PR ( HR =2.80, P <0.01). Conclusions: MM patients undergoing HD had higher percentage of coronary heart disease, pulmonary infection, and serum calcium, lower percentage of diabetes, lower hemoglobin and platelet. The survival of MM patients required HD was poor, with high risk of mortality. Age, vascular access of HD, albumin and hematological response were correlated with survival of patients.