Outcomes of Newly Diagnosed Multiple Myeloma Patients Requiring Dialysis

Renal impairment (RI) is a common complication in newly diagnosed multiple myeloma (NDMM), with 1-5% of patients presenting with severe RI requiring dialysis, which is associated with significant morbidity and early mortality. Limited real-world data exist on outcomes for these patients.

We assessed renal response patterns and outcome determinants in 73 consecutive NDMM patients requiring dialysis, treated in a single centre (2010 to 2023).

Median age was 69 years; 52% had high-risk cytogenetics. All patients received bortezomib-based induction therapy (19% doublets, 71% triplets, 10% quadruplets; 12% anti-CD38 antibodies). Median follow-up was 37.2 months. Dialysis independence was achieved by 31 patients (42.5%) after a median of 52 days (range 3-247). Dialysis independence was associated with improved survival (median 36 vs. 13.3 months, P = .085) and lower early mortality (3.2% vs. 14.3%, P = .15). Factors associated with independence from dialysis were younger age) OR 0.92, P = .003), hypercalcemia (OR 1.43, P = .013) and hematologic response (≥ PR) at 1 month (OR 3.7, P = .015). In multivariate analysis, younger age (P = .012, OR 0.93) and hematologic response (≥ PR) at 1 month (P = .014, OR 4.94) were independent predictors of dialysis independence. Depth of hematologic response (≥ VGPR) significantly impacted renal recovery (OR 4.0, P = .020). High-risk cytogenetics independently predicted poor outcomes (HR 3.67, P = .003).

Dialysis independence is achievable in 42.5% of NDMM patients without special filters in the era of bortezomib-based regimens, with significant impact on outcome. Outcomes remain poor overall for patients who are dialysis-dependent at diagnosis and further evaluation of quadruplet regimens with anti-CD38 antibodies is needed.