MM-324: Efficacy of Autologous Stem Cell Transplantation in Multiple Myeloma Patients with Renal Failure

Context According to the Russian register, renal impairment at the time of diagnosis was noted in every fifth patient with multiple myeloma (MM). Objective To study the efficacy and safety of high-dose therapy followed by ASCT in patients with MM and renal failure. Patients and Methods A retrospective single-center study included 64 (30 males, 34 females) MM patients with renal failure aged 19 to 65 years (median 54) who underwent ASCT during a period from 2013 to 2019. At the time of diagnosis, median serum creatinine level was 462 pmol/L and median GFR was 10 ml/min/1.73 m2 (CKD-EPI). Twenty-three patients (36%) were dialysis-dependent at the time of diagnosis. Before ASCT, the OR rate was documented in 91% of cases. Renal response was achieved in 80% of patients. In 13 of 23 cases (57%), dialysis was stopped after induction therapy. Ten patients were dialysis-dependent at the time of ASCT. The analysis was carried out in subgroup A: patients without dialysis at the time of ASCT (n = 54) and subgroup B: dialysis-dependent patients at the time of ASCT (n = 10). Results In subgroup B patients compared to subgroup A patients, significant differences were observed in the requirement of red blood cell transfusions (100% vs 37%, p = 0.001). One hundred days after ASCT, the achievement of OR rate increased from 91 to 96%, and the percentage of CR increased from 45% to 64%. After auto-HSCT, there was an increase in the rate of achieving complete renal responses, from 28% to 34%. In one case, dialysis was stopped after the transplantation. So, at the time of diagnosis, 23 patients were dependent on renal replacement therapy. Because of induction therapy with auto-HSCT, 14 patients (61%) became hemodialysis-independent. Follow-up of these patients lasted from 1.5 to 7 years. There was no transplant-related mortality. After a median follow-up of 48 months, 5-year overall survival (OS) was 70%, and 5-year progression-free survival (PFS) was 42%. Conclusions ASCT is a feasible, safe, and effective method of treatment in MM patients with severe kidney injury. In our study, 14 of 23 patients (61%) became dialysis-independent. Overall, this work confirmed dialysis-dependent MM patients should not be excluded from high-dose therapy followed by ASCT.