Survival and Renal Recovery in Newly Diagnosed Multiple Myeloma Patients Presenting With Dialysis‐Requiring Severe Renal Impairment

BACKGROUND: Severe renal insufficiency requiring dialysis in newly diagnosed multiple myeloma (NDMM) patients has been independently associated with poor survival outcomes. However, there is a paucity of data on factors predicting renal recovery and survival outcomes of these patients. METHODS: We retrospectively analyzed outcomes in NDMM patients presenting with severe dialysis-requiring RI from 01/2010 to 12/2022. RESULTS: Seventy patients were identified; all receiving novel agent-based induction (bortezomib-based 96%; lenalidomide-based 3%)-73% (n = 51) underwent ASCT. Thirty-three (48%) patients became dialysis independent; early achievement of VGPR in < 4.4 months from treatment initiation was identified as the only factor predicting renal recovery and dialysis withdrawal on univariate analysis (Hazard ratio [HR] of 4.172; p-value = 0.0014). At median follow-up of 39 months, the median overall survival (OS) of dialysis-requiring NDMM patients was 98.3 months with 2- and 5-year OS rates of 84% and 67%, respectively; 2- and 5-year progression-free survival (PFS) rates were 66.9% and 43.7%, respectively. On multivariable analysis, low LDH at diagnosis (HR: 1.003, p = 0.0092), undergoing ASCT (HR: 0.213; p-value = 0.0016), and dialysis independence (HR: 0.311; p-value = 0.0112) independently predicted improved OS. CONCLUSIONS: Early VGPR and hemodialysis independence translated to improved survival, providing a benchmark for future comparison as anti-CD38 monoclonal antibodies enter first line therapy.