Incidence and predictive factors of platinum‐associated nephrotoxicity in patients with lymphoid malignancies; a 15‐year experience outside clinical trials

Introduction: Platinum-based chemotherapy is widely used in patients with lymphoma either in first or successive lines of treatment. However, platinum is well known to be nephrotoxic and could impact in clinical outcomes. Methods: An unicentric retrospective cohort study was carried out including lymphoma patients who received platinum-based chemotherapy between 2007 and 2022. Renal failure (RF) was defined as a decrease in creatinine clearance by 50% or an elevation of plasma creatinine a 50% over the previous level. Patients who received treatment in first line and those who were intended to proceed to cellular therapy were included. Patients on clinical trials were excluded. The final cohort was assessed for incidence of RF and clinical and laboratory variables were evaluated as risk factors. Results: A total of 123 patients were included. Baseline characteristics are summarized in Figure 1A. The incidence of RF was 41.5% (51/123). Median time to RF was 6 days (range: 1–28). RF persisted until data cut-off date in 20/51 (39.2%), and 4/51 (7.8%) patients required dialysis. Following variables: sex, body mass index, diabetes, dyslipidemia, use of anti-CD20 and the type of chemotherapy were not associated to an increased risk of RF. Administration of magnesium supplements and mannitol had no impact on RF. Significant differences were observed between the RF and the no-RF groups in age (58.3 vs. 48.3 years; p < 0.001), hypertension (41.2% vs. 13.9%; p < 0.001), albumin (3.2 vs. 3.7 g/dL; p < 0.001) and hemoglobin (10.9 vs. 12.5 g/dL; p < 0.001). We used the cut-off of 51 years (assessed by the optimal point of the ROC curve) for age to be included in a logistic regression model with categoric predictors. The cut-off values of 3.5 g/dL for albumin and 10 g/dL of hemoglobin were chosen based on a biological basis. These four variables were associated with an increased risk of RF showing univariable odds ratio (OR) of 3.7 (1.7–8) for age, 4.3 (1.8–10.4) for hypertension, 4.3 (2–9.2) for albumin and 4.3 (1.8–10.4) for hemoglobin. A multivariable logistic regression model was built including these variables; having hypertension and hemoglobin <10 remained as significant predictors – OR: 1.8 (1.1–2.9) and 2.8 (1.1–7.6) respectively –, whereas age <51 and albumin kept an OR of 1.9 (0.8–4.9) and 2.3 (0.9–5.5) which resulted non statistically significant. Developing renal failure after platinum treatment was associated with a significant decrease in overall survival (OS); median OS in RF and no-RF groups were: 2.4 versus 6.2 years respectively (Figure 1B, log-rank test: 6.67; p = 0.009). Keywords: late effects in lymphoma survivors, other, risk models No conflicts of interests pertinent to the abstract.