ABSTRACT
Survival for patients with multiple myeloma has increased. Both melphalan and lenalidomide are associated with subsequent development of myelodysplasia. We reviewed the cases of all patients with multiple myeloma who had subsequent development of myelodysplastic syndrome (MDS) or acute non-lymphoblastic leukemia (ANLL) during a 12-year period in three centers. Of 55 patients identified, two received only lenalidomide before myelodysplasia developed. The median time between the diagnoses of multiple myeloma and MDS/ANLL was 52.7 months. Median survival after the diagnosis of MDS or ANLL was 6.7 months. Treatment of MDS comprised allogeneic stem cell transplant in eight patients (median survival, 219 days; one patient alive at 624 days) and a hypomethylating agent in 21 patients (response of stable or better in five patients). Myelodysplasia remains a devastating complication of therapy for multiple myeloma, with short survival and poor response rates to available modalities.
Subject(s)
Antineoplastic Agents/adverse effects , Leukemia, Myeloid, Acute/chemically induced , Multiple Myeloma/drug therapy , Myelodysplastic Syndromes/chemically induced , Acute Disease , Aged , Aged, 80 and over , Angiogenesis Inhibitors/adverse effects , Bortezomib/adverse effects , Female , Humans , Lenalidomide , Leukemia, Myeloid, Acute/diagnosis , Male , Middle Aged , Multiple Myeloma/pathology , Myelodysplastic Syndromes/diagnosis , Stem Cell Transplantation , Thalidomide/adverse effects , Thalidomide/analogs & derivatives , Transplantation, AutologousABSTRACT
OBJECTIVES: To evaluate the effects of predialytic oral nutritional supplementation in chronic kidney disease (CKD) patients on maintenance haemodialysis (MHD). METHODS: NEPRO HP was provided to 77 CKD patients on maintenance haemodialysis (MHD) over 3 months. Efficacy parameters were improvement in albumin levels, weight and haemoglobin levels; safety parameters were serum potassium and phosphorus values; other parameters were SGA and MIS scores. RESULTS: Mean serum albumin values showed a statistically significant increase. There was a statistically significant improvement in the mean body weight and haemoglobin of the patients in the second and third months of treatment. Serum phosphorus and potassium levels did not change in a statistically significant manner. There was improvement in nourishment status as detected by MIS and SGA scores. Two patients expired during the course of the study. CONCLUSION: Predialytic oral supplementation with NEPRO HP improves nutritional status of CKD patients on MHD.
