J Hematol

Journal of Hematology, ISSN 1927-1212 print, 1927-1220 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Hematol and Elmer Press Inc

Journal website http://www.thejh.org

Original Article

Volume 5, Number 1, March 2016, pages 8-16

Associations Between Initial Presentation of Multiple Myeloma and Renal Function: the Experience of Two European Centers

Figure 1. Survival rate in the 41 patients with para-protein related biopsy findings according to the renal pathological diagnosis (MCN, LCDD, and AL-amyloidosis). Y axis: cumulative survival; x-axis: length of follow-up in days. Group 0: AL-amyloid (blue); group 1: MCN (green); group 2: LCDD (yellow). MCN: myeloma cast nephropathy; LCDD: light chain deposition disease.

Figure 2. The 12-month survival in NRI (no renal impairment) and AKI (acute kidney injury) in UK patients. Group 1 (blue): NRI patients; group 2 (red): AKI patients. Y-axis: survival probability; x-axis: length of follow-up in months.

Figure 3. The 12-month survival between chemotherapy treated vs. untreated UK patients. Red: chemotherapy treated; blue: untreated cohort. Y-axis: survival probability; x-axis: length of follow-up in months.

**Table 1.** Demographic, Renal and Hematological Features
	NRI	AKI	P
CVE: cardiovascular event; AF: atrial fibrillation; MGUS: monoclonal gammopathy of unknown significance; eGFR: estimated glomerular filtration rate; FKLC: free kappa light chain; FLLC: free lambda light chain; KLR: kappa lambda ratio; Hb: hemoglobin; WBC: white blood cell.
Age	63.82 ± 13.06 years	67.03 ± 10.52 years	0.043
Male gender	53.1%	61%	0.230
CVE	16.7%	17.1%	0.942
Diabetes	13.4%	5.8%	0.205
Hypertension	36.4%	35.5%	0.896
AF	12.2%	12.5%	1.00
MGUS	11.7%	18.1%	0.170
Previous cancer	6.1%	6.6%	0.432
Sodium	138.4 ± 3.8 mmol/L	137.0 ± 4.7 mmol/L	0.01
Potassium	4.2 ± 0.4 mmol/L	4.4 ± 0.7 mmol/L	0.002
Urea	6.1 ± 2.6 mmol/L	20.5 ± 13.8 mmol/L	< 0.001
eGFR	85.52 ± 13.4 mL/min/1.73 m²	23.21 ± 21.3 mL/min/1.73 m²	< 0.001
Calcium	2.3 ± 0.2 mmol/L	2.54 ± 0.4 mmol/L	0.006
Phosphate	1.08 ± 0.4 mmol/L	1.61 ± 0.7 mmol/L	< 0.001
Albumin	38.7 ± 6.2 g/L	34.6 ± 7.7 g/L	< 0.001
Proteinuria	0.4 ± 0.6 g/24 h	1.86 ± 1.8 g/24 h	< 0.001
Plasma cells (%)	25.1 ± 20.8	35.3 ± 26.5	0.01
IgA	4.3 ± 11.9 g/L	7.07 ± 14.3 g/L	0.67
IgM	0.4 ± 0.4 g/L	1.6 ± 8.3 g/L	0.14
FKLC	503.1 ± 1,523.7 mg/L	2,297.2 ± 4,822.9 mg/L	0.01
FLLC	494.2 ± 1,685.5 mg/L	1,464.3 ± 3,084.9 mg/L	0.04
KLR	36.1 ± 115.6	385 ± 962.7	0.02
Paraprotein	22.8 ± 14.7 g/L	24.7 ± 19.5 g/L	0.53
Hb	118.98 ± 19.9 g/L	94.54 ± 17.5 g/L	< 0.001
WBC	6.5 ± 2.7 × 10⁹/L	7.9 ± 3.5 × 10⁹/L	0.004
Platelets	239.5 ± 81 × 10⁹/L	219.4 ± 102.9 × 10⁹/L	0.14

Table 1. Demographic, Renal and Hematological Features

NRI

AKI

CVE: cardiovascular event; AF: atrial fibrillation; MGUS: monoclonal gammopathy of unknown significance; eGFR: estimated glomerular filtration rate; FKLC: free kappa light chain; FLLC: free lambda light chain; KLR: kappa lambda ratio; Hb: hemoglobin; WBC: white blood cell.

Age

63.82 ± 13.06 years

67.03 ± 10.52 years

0.043

Male gender

53.1%

61%

0.230

CVE

16.7%

17.1%

0.942

Diabetes

13.4%

5.8%

0.205

Hypertension

36.4%

35.5%

0.896

12.2%

12.5%

1.00

MGUS

11.7%

18.1%

0.170

Previous cancer

6.1%

6.6%

0.432

Sodium

138.4 ± 3.8 mmol/L

137.0 ± 4.7 mmol/L

0.01

Potassium

4.2 ± 0.4 mmol/L

4.4 ± 0.7 mmol/L

0.002

Urea

6.1 ± 2.6 mmol/L

20.5 ± 13.8 mmol/L

< 0.001

eGFR

85.52 ± 13.4 mL/min/1.73 m²

23.21 ± 21.3 mL/min/1.73 m²

< 0.001

Calcium

2.3 ± 0.2 mmol/L

2.54 ± 0.4 mmol/L

0.006

Phosphate

1.08 ± 0.4 mmol/L

1.61 ± 0.7 mmol/L

< 0.001

Albumin

38.7 ± 6.2 g/L

34.6 ± 7.7 g/L

< 0.001

Proteinuria

0.4 ± 0.6 g/24 h

1.86 ± 1.8 g/24 h

< 0.001

Plasma cells (%)

25.1 ± 20.8

35.3 ± 26.5

0.01

IgA

4.3 ± 11.9 g/L

7.07 ± 14.3 g/L

0.67

IgM

0.4 ± 0.4 g/L

1.6 ± 8.3 g/L

0.14

FKLC

503.1 ± 1,523.7 mg/L

2,297.2 ± 4,822.9 mg/L

0.01

FLLC

494.2 ± 1,685.5 mg/L

1,464.3 ± 3,084.9 mg/L

0.04

KLR

36.1 ± 115.6

385 ± 962.7

0.02

Paraprotein

22.8 ± 14.7 g/L

24.7 ± 19.5 g/L

0.53

118.98 ± 19.9 g/L

94.54 ± 17.5 g/L

< 0.001

WBC

6.5 ± 2.7 × 10⁹/L

7.9 ± 3.5 × 10⁹/L

0.004

Platelets

239.5 ± 81 × 10⁹/L

219.4 ± 102.9 × 10⁹/L

0.14

**Table 2.** Comparison Between the Two European Centers
	UK group	Italian group	P
CVE: cardiovascular events; AF: atrial fibrillation; MGUS: monoclonal gammopathy of unknown significance.
Age	66.7 ± 11.5 years	65.3 ± 14.3 years	0.092
Male gender	55%	56.5%	0.830
CVE	17.4%	25%	0.582
Diabetes	11.9%	26.7%	0.099
Hypertension	37.2%	54.1	0.052*
AF	9.2%	18.2%	0.320
MGUS	7%	42%	0.000*
Cancer	6.9%	20%	0.038*

Table 2. Comparison Between the Two European Centers

UK group

Italian group

CVE: cardiovascular events; AF: atrial fibrillation; MGUS: monoclonal gammopathy of unknown significance.

Age

66.7 ± 11.5 years

65.3 ± 14.3 years

0.092

Male gender

55%

56.5%

0.830

CVE

17.4%

25%

0.582

Diabetes

11.9%

26.7%

0.099

Hypertension

37.2%

54.1

0.052*

9.2%

18.2%

0.320

MGUS

42%

0.000*

Cancer

6.9%

20%

0.038*

**Table 3.** Clinical and Laboratory Features According to the Renal Pathologic Diagnosis
	MCN (51%)	LCDD (17%)	AL-amyloidosis (9.4%)	P
Age	65 ± 7.6 years	60 ± 14.0 years	72 ± 8.0 years	0.1
eGFR	9.1 ± 4.4 mL/min/1.73 m²	25.4 ± 23.5 mL/min/1.73 m²	47.5 ± 39.4 mL/min/1.73 m²	0.001
Hb	89.7 ± 11.8 g/L	102.2 ± 24.1 g/L	131.7 ± 13.8 g/L	0.001
PLT	179.1 ± 99.7 × 10⁹/L	289.2 ± 114.8 × 10⁹/L	210.7 ± 90.0 × 10⁹/L	0.038
TP	72.2 ± 17.9 g/L	68.3 ± 13.0 g/L	52.4 ± 4.4 g/L	0.05
% PC	29.2 ± 21.3	15 ± 9.7	6.2 ± 4.5	0.04

Table 3. Clinical and Laboratory Features According to the Renal Pathologic Diagnosis

MCN (51%)

LCDD (17%)

AL-amyloidosis (9.4%)

Age

65 ± 7.6 years

60 ± 14.0 years

72 ± 8.0 years

0.1

eGFR

9.1 ± 4.4 mL/min/1.73 m²

25.4 ± 23.5 mL/min/1.73 m²

47.5 ± 39.4 mL/min/1.73 m²

0.001

89.7 ± 11.8 g/L

102.2 ± 24.1 g/L

131.7 ± 13.8 g/L

0.001

PLT

179.1 ± 99.7 × 10⁹/L

289.2 ± 114.8 × 10⁹/L

210.7 ± 90.0 × 10⁹/L

0.038

72.2 ± 17.9 g/L

68.3 ± 13.0 g/L

52.4 ± 4.4 g/L

0.05

% PC

29.2 ± 21.3

15 ± 9.7

6.2 ± 4.5

0.04

**Table 4.** Most common causes of death in the entire population
Causes of death	Patients (%)
MOF: multi-organ failure; DIC: disseminated intravascular coagulation; MI: myocardial infarction.
Infection	56 (76.9%)
Uremia	6 (8.2%)
MOF	3 (4.1%)
Bleeding/DIC	3 (4.1%)
MI	3 (4.1%)
Malignancy	1 (1.3%)
Stroke	1 (1.3%)

Table 4. Most common causes of death in the entire population

Causes of death

Patients (%)

MOF: multi-organ failure; DIC: disseminated intravascular coagulation; MI: myocardial infarction.

Infection

56 (76.9%)

Uremia

6 (8.2%)

MOF

3 (4.1%)

Bleeding/DIC

3 (4.1%)

Malignancy

1 (1.3%)

Stroke

1 (1.3%)

**Table 5.** Backwards and Forwards Cox’s Model for Death in the UK Subgroup
	HR	P
AF: atrial fibrillation; FKLC: free kappa light chain.
Backwards Cox’s model
AF	5.17 (0.57 - 46.97)	0.144
Age	1.08 (0.98 - 1.19)	0.104
% Plasma cells	1.05 (1.01 - 1.09)	0.015
Proteinuria	0.36 (0.12 - 1.04)	0.059
Paraprotein	1.04 (1 - 1.09)	0.053
Forwards Cox’s model
AF	8.76 (0.73 - 104.77)	0.087
Age	1.1 (0.99 - 1.22)	0.069
% Plasma cells	1.06 (1.01 - 1.12)	0.01
Proteinuria	0.28 (0.09 - 0.93)	0.037
FKLC	1 (1 - 1)	0.005
Paraprotein	1.05 (1 - 1.11)	0.037

Table 5. Backwards and Forwards Cox’s Model for Death in the UK Subgroup

AF: atrial fibrillation; FKLC: free kappa light chain.

Backwards Cox’s model

5.17 (0.57 - 46.97)

0.144

Age

1.08 (0.98 - 1.19)

0.104

% Plasma cells

1.05 (1.01 - 1.09)

0.015

Proteinuria

0.36 (0.12 - 1.04)

0.059

Paraprotein

1.04 (1 - 1.09)

0.053

Forwards Cox’s model

8.76 (0.73 - 104.77)

0.087

Age

1.1 (0.99 - 1.22)

0.069

% Plasma cells

1.06 (1.01 - 1.12)

0.01

Proteinuria

0.28 (0.09 - 0.93)

0.037

FKLC

1 (1 - 1)

0.005

Paraprotein

1.05 (1 - 1.11)

0.037