Outcomes of Multiple Myeloma Hospitalization Undergoing Autologous Stem Cell Transplantation with and without CKD: A NIS 2016 to 2020 Database Study

Outcomes of Multiple Myeloma Hospitalization undergoing autologous stem cell transplantation with and without CKD: A NIS 2016 to 2020 database study.

Objective:

This study aimed to compare hospital outcomes between multiple myeloma patients undergoing autologous stem cell transplantation (ASCT) with and without chronic kidney disease (CKD) using data from the National Inpatient Sample (NIS) from 2016 to 2020.

Methods:

A retrospective analysis of the NIS database was conducted using International Classification of Diseases (ICD-10) codes to identify hospitalization who underwent ASCT for multiple myeloma. STATA version MP14.2 was used mainly for analysis. We used Fischer's exact test to compare proportions, the student's t-test to compare continuous variables, and multivariate regression analysis to calculate the adjusted odds ratio. Following are included in transplant complications (transplant rejection, failure, transplant infection).

Results:

Among 31,390 hospitalized, 4,930 had co-existing CKD. The mean age was 61.65 years. The majority were male (64.2%), with an increased Charlson comorbidity index with a majority >6. On multivariant analysis compared to hospitalization without CKD, those with CKD showed a significantly higher risk of transplant complications (adjusted odds ratio [AOR]: 1.90, 95% confidence interval [CI]: 1.21-2.99, P = 0.006), AKI (AOR: 5.43, 95% CI: 4.47-6.59, P < 0.001), AKI requiring dialysis (AOR: 2.16, 95% CI: 2.14-11.94, P < 0.001), blood transfusion (AOR: 1.32, 95% CI: 1.00-1.75, P = 0.048), and in-hospital mortality (AOR: 2.16, 95% CI: 1.13-4.12, P = 0.02). Additionally, there was a non-significant increase in the rate of platelet transfusion and ICU admission. Hence, patients with CKD had a significantly longer average length of hospital stay (18.27 vs. 16.26. p< 0.001) and higher total cost of hospital stay ($217,202 vs. $199,062, P=0.02) compared to those without CKD.

Conclusion:

Multiple myeloma patients undergoing ASCT with co-existing CKD experienced poorer hospital outcomes, including a higher risk of transplant-related complications, AKI, blood transfusion, and in-hospital mortality resulting in prolonged hospital stays and higher healthcare costs. Since multiple myeloma has a higher incidence of CKD, further studies are warranted to explore interventions based on the stage of CKD to improve the outcomes of ASCT in multiple myeloma patients with CKD.