Renal Impairment at Diagnosis in Myeloma: Patient Characteristics, Treatment, and Impact on Outcomes. Results From the Australia and New Zealand Myeloma and Related Diseases Registry

Clin Lymphoma Myeloma Leuk. 2019 Aug;19(8):e415-e424. doi: 10.1016/j.clml.2019.05.010. Epub 2019 May 16.


Background: Renal impairment (RI) is a common complication of multiple myeloma (MM) and remains a poor prognostic factor despite improved survival with newer therapies.

Patients and methods: We evaluated baseline characteristics, treatment, and outcomes of newly diagnosed MM patients with RI at diagnosis in the Australia and New Zealand Myeloma and Related Diseases Registry over 5 years to April 2018; we compared patients with RI (estimated glomerular filtration rate [eGFR] <60 mL/min/1.73 m2) with those with eGFR ≥60. In autologous stem cell transplantation (ASCT) analyses, patients aged 70 years and younger and ≥1 year from diagnosis were included.

Results: Overall, 36% of patients with newly diagnosed MM had RI; they were older, had more advanced disease and comorbidities, and worse performance status. Bortezomib-based induction therapy was most commonly used, although administered to fewer RI patients, despite similar response rates. Patients with RI were less likely to receive ASCT; however, recipients had longer progression-free survival (PFS) and overall survival (OS). Patients with RI had shorter OS and PFS after adjusting for age. In ASCT recipients with RI versus no RI, there was no difference in PFS and OS.

Conclusion: Our findings in "real world" MM patients with RI confirm that patient-, disease-, and treatment-related factors (such as suboptimal bortezomib and ASCT use), and delays in commencing therapy, might contribute to poorer outcomes, and support the use of ASCT in patients with RI.

Keywords: Autologous; Multiple myeloma; Registry; Renal Impairment; Transplantation.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Australia
  • Bortezomib / administration & dosage
  • Child
  • Child, Preschool
  • Combined Modality Therapy
  • Dexamethasone / administration & dosage
  • Female
  • Follow-Up Studies
  • Glomerular Filtration Rate
  • Hematopoietic Stem Cell Transplantation / mortality*
  • Humans
  • Infant
  • Male
  • Middle Aged
  • Multiple Myeloma / complications
  • Multiple Myeloma / mortality*
  • Multiple Myeloma / pathology
  • Multiple Myeloma / therapy
  • Oligopeptides / administration & dosage
  • Prognosis
  • Prospective Studies
  • Registries / statistics & numerical data*
  • Renal Insufficiency / etiology
  • Renal Insufficiency / mortality*
  • Renal Insufficiency / pathology
  • Renal Insufficiency / therapy
  • Survival Rate
  • Transplantation, Autologous
  • Young Adult


  • Oligopeptides
  • Bortezomib
  • carfilzomib
  • Dexamethasone