Retrospective study reports substantial toxicity alongside 65% two-year survival in myeloma patients with renal impairment, highlighting the need for careful dosing and selection.
Key Points
To evaluate toxicity, survival outcomes, and prognostic factors in patients with multiple myeloma and renal impairment undergoing autologous hematopoietic cell transplantation in a resource-constrained setting.
Retrospective single-center study of N=53 multiple myeloma patients with renal impairment (creatinine > 2 mg/dL or clearance < 40 mL/min) undergoing AHCT between 2010 and 2023 at a public hospital in Brazil.
Conditioning melphalan was administered at ≤ 140 mg/m² in 81% of patients, and 28% (n=15) were dialysis-dependent at the time of transplant.
Grade 3–4 overall toxicity occurred in 29% of patients, 26% required intensive care unit admission, and 100-day non-relapse mortality was 13%.
The 24-month progression-free survival rate was 48% and overall survival was 65%.
Grade 3–4 toxicity was significantly associated with melphalan > 140 mg/m² (p=.043), partial response vs. better (p=.024), and low albumin (p=.018), while dialysis dependence predicted worse PFS (p=.035).