Current Trends of Severe Renal Impairment in Newly Diagnosed Multiple Myeloma: A Single-Center Experience in a Low Socio-Economic Population

Background: Recent advancements in multiple myeloma (MM) diagnosis and treatment significantly improved patients' survival and quality of life. Severe Renal Impairment (RI) remains a significant challenge in newly diagnosed MM (NDMM), complicating treatment and affecting outcomes. Prior studies reported improved overall renal recovery in the era of novel therapies. However, there is a lack of evidence documenting the outcomes of patients presenting with severe RI. We present an updated analysis of the characteristics and outcomes of patients with NDMM presenting with severe RI in an ethnically diverse, low socio-economic population.

Methods: A single-center retrospective review of patients with NDMM presenting to Montefiore Medical Center (Bronx, New York) was conducted from 2011-2023. Severe RI was defined as an estimated glomerular filtration rate (eGFR) of less than 30 mL/min/1.73 m². MM risk was assessed using the mSMART 3.0 tool.

Results: Out of 284 patients with NDMM, 58 (20%) patients presented with severe RI. Black patients (p = 0.018) and older adults (64 years vs 60 years, p value 0.032) were more likely to present with severe RI. Severe RI at diagnosis correlated with high-risk myeloma (p = 0.002), high R-ISS stage (p < 0.001), and a lower likelihood of receiving stem cell transplants (p < 0.001). Among those with severe RI, 23/58 required dialysis of which 6/23 were taken off dialysis at last follow-up after renal recovery. Median eGFR at diagnosis, 6 months and 1 year after diagnosis was 11, 23 and 23.5 ml/min/1.73 m2, respectively. 14 out of 58 patients (39%) achieved renal recovery to eGFR > 30 one year post-diagnosis, with no significant difference in race, sex, or ethnicity. The most common first-line treatment for patients with severe RI was CyBorD (62%). The median time from diagnosis to first treatment (including plasma exchange) was 10 days. By the last follow-up, 35/58 patients (60%) had a stem cell transplant, with a median time from diagnosis to transplant of 275 days. The median overall survival (OS) for patients with severe RI at diagnosis was 49 months, while it was not reached for those without severe RI (p < 0.001). Early death (≤ 2 months after diagnosis) occurred in 2 patients, both with severe RI. Among patients with severe RI, multivariate Cox regression survival analysis showed that achieving free light chain (FLC) below 500 mg/L (HR 0.212, p < 0.001) and receiving a stem cell transplant (HR 0.209, p 0.002) improved outcome.

Conclusions: Despite improvements in the life expectancy of patients with MM, severe renal failure remains a challenge, particularly among minorities. Socioeconomic factors need to be explored as a contributor to outcomes in patients with severe RI. Achieving FLC clearance and undergoing stem cell transplant may play a role in survival in patients with NDMM and severe RI.

Shastri:Kymera: Research Funding; Jassen: Consultancy; Gilead, Rigel, Kymera: Consultancy; NACE & PeerView: Honoraria; Ryvu therapeutics: Research Funding; Geron: Speakers Bureau. Konopleva:Janssen: Consultancy, Other: clinical trials; Allogene: Research Funding; AstraZeneca: Consultancy, Other: clinical trials, Research Funding; Auxenion GmbH: Membership on an entity's Board of Directors or advisory committees; Redona: Consultancy; Pfizer: Other: clinical trials; MEI Pharma: Consultancy, Research Funding; ImmunoGen: Research Funding; Genentech: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: clinical trials, Research Funding; Legend Biotech: Consultancy; Immune Oncology: Membership on an entity's Board of Directors or advisory committees; F. Hoffmann-LaRoche: Consultancy, Membership on an entity's Board of Directors or advisory committees; AbbVie: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: clinical trials, Research Funding; Bakx Therapeutics: Membership on an entity's Board of Directors or advisory committees; Precision Biosciences: Research Funding; Reata Pharmaceutical: Other: IP; Gilead: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Vincerx: Consultancy, Membership on an entity's Board of Directors or advisory committees; Dark Blue Therapeutics: Membership on an entity's Board of Directors or advisory committees; Boehringer: Consultancy; Rafael Pharmaceutical: Research Funding; Menarini Group: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: clinical trials, Research Funding; Cellectis: Other: Clinical Trials; Sellas: Consultancy; Sanofi Aventis: Consultancy, Other: clinical trials, Research Funding. Feldman:Stelexis: Consultancy. Verma:Bioconvergent health: Current equity holder in private company; Prelude: Research Funding; Bristol Myers Squib: Research Funding; Curis: Membership on an entity's Board of Directors or advisory committees, Research Funding; Halia: Research Funding; Calico: Membership on an entity's Board of Directors or advisory committees; Clinstreet: Current equity holder in private company; Stelexis: Current equity holder in private company, Membership on an entity's Board of Directors or advisory committees.