Renal Outcomes Following Autologous Stem Cell Transplantation in Dialysis-Dependent Patients With Multiple Myeloma: A...

Multiple myeloma (MM) frequently causes renal impairment, and a subset of patients progresses to end-stage renal disease (ESRD) requiring dialysis. Dialysis dependence has historically been considered a relative contraindication to high-dose conditioning and autologous stem cell transplantation (ASCT). Emerging evidence indicates that ASCT may provide effective hematologic control and, in selected patients, renal recovery.

We conducted a retrospective case series of five dialysis-dependent patients with MM who underwent ASCT at An-Najah National University Hospital. Demographic and clinical characteristics, transplant variables, supportive-care measures, infectious and noninfectious complications, hematologic recovery, admission and discharge laboratory values, and short-term outcomes were extracted from the medical records.

The five patients had a mean age of 56 years and received reduced-dose melphalan (140 mg/m²), followed by peripheral-blood CD34+ cell infusion. The mean CD34+ collection and infusion doses were 4.3 × 10⁶/kg and 4.1 × 10⁶/kg, respectively. All patients achieved engraftment; mean neutrophil and platelet engraftment occurred on Days 13.0 and 19.4, respectively. Four patients (80%) developed neutropenic fever. Clostridioides difficile and Staphylococcus epidermidis were the most frequently documented pathogens. Two patients developed central line-associated bloodstream infection and septic shock. No 100-day treatment-related mortality occurred. Creatinine and blood urea nitrogen remained elevated, and all patients continued maintenance hemodialysis at discharge.

ASCT was feasible in carefully selected dialysis-dependent patients with MM and was associated with timely hematologic recovery and no 100-day treatment-related mortality. Infectious complications and vascular-access management remain major clinical concerns. Larger prospective studies are needed to define long-term renal outcomes and predictors of dialysis independence.