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.