Wang Ji-Nuo, Wang Chenyun, Ying Jinping, Zheng Gaofeng, Han Xiaoyan, An Peng, Wang Gang, Chen Fei, Yang Li, Yang Yang, He Donghua, He Jingsong, Chen Yuanshuai, Wu Wenjun, Cai Zhen
Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou, Zhejiang, China.
Institute of Hematology, Zhejiang University, Hangzhou, Zhejiang, China.
Ther Adv Med Oncol. 2025 Aug 21;17:17588359251357682. doi: 10.1177/17588359251357682. eCollection 2025.
Patients with multiple myeloma (MM) and renal impairment (RI), particularly those requiring dialysis, have historically experienced poor outcomes. Despite advancements in targeted therapies, the prognosis of dialysis-dependent MM and factors influencing dialysis independence remain unclear.
This study aimed to provide a comprehensive analysis of the clinical manifestations and treatment outcomes of dialysis-dependent MM patients in China, and to explore the factors associated with dialysis independence and long-term survival.
We conducted a multicenter, retrospective, real-world cohort study.
This multicenter, retrospective study included 122 MM patients requiring chronic hemodialysis (⩾28 days of treatment) at 4 comprehensive hospitals in China from January 2012 to November 2023. Hemodialysis resulting from causes other than MM was excluded. Logistic regression was employed for multivariate analysis of factors associated with dialysis independence, and Kaplan-Meier survival curves and Cox proportional hazard models were utilized for survival analysis.
Among the 122 patients, 74 patients (60.7%) were male, with a median age of 65 (39-87) years. Of these, 71.3% ( = 87) had newly diagnosed MM (NDMM), and 28.7% ( = 35) had relapsed/refractory MM (RRMM). Dialysis independence was achieved in 27 patients (22 with NDMM and 5 with RRMM). Proteasome inhibitors were used in 80.3% of patients ( = 98), while 13.9% ( = 17) received daratumumab-based regimens. After a median follow-up of 43.7 months, the median progression-free survival (PFS) was 14.4 months (95% confidence interval (CI): 3.6-25.2), and the median overall survival (OS) was 27.4 months (95% CI: 6.9-47.9). Dialysis-independent patients had significantly longer PFS (36.7 vs 9.4 months, = 0.006) and OS (62.6 vs 17.7 months, < 0.001). Factors associated with dialysis independence included achieving a very good partial response (VGPR), receiving daratumumab-based regimens, reduction in serum-free light chain ⩾80% after the first chemotherapy cycle, and age <65 years.
In the era of new drugs, dialysis-dependent MM still has a poor prognosis, although dialysis independence improves survival.
多发性骨髓瘤（MM）合并肾功能损害（RI）的患者，尤其是那些需要透析的患者，历来预后较差。尽管靶向治疗取得了进展，但依赖透析的MM患者的预后以及影响透析独立性的因素仍不明确。
本研究旨在全面分析中国依赖透析的MM患者的临床表现和治疗结果，并探讨与透析独立性和长期生存相关的因素。
我们进行了一项多中心、回顾性、真实世界队列研究。
这项多中心回顾性研究纳入了2012年1月至2023年11月在中国4家综合医院需要进行慢性血液透析（治疗时间≥28天）的122例MM患者。排除由MM以外的原因导致的血液透析。采用逻辑回归对与透析独立性相关的因素进行多变量分析，并利用Kaplan-Meier生存曲线和Cox比例风险模型进行生存分析。
122例患者中，74例（60.7%）为男性，中位年龄为65岁（39 - 87岁）。其中，71.3%（n = 87）为新诊断的MM（NDMM），28.7%（n = 35）为复发/难治性MM（RRMM）。27例患者实现了透析独立（22例NDMM和5例RRMM）。80.3%（n = 98）的患者使用了蛋白酶体抑制剂，而13.9%（n = 17）接受了基于达雷妥尤单抗的方案。中位随访43.7个月后，中位无进展生存期（PFS）为14.4个月（95%置信区间（CI）：3.6 - 25.2），中位总生存期（OS）为27.4个月（95% CI：6.9 - 47.9）。透析独立的患者PFS（36.7 vs 9.4个月，P = 0.006）和OS（62.6 vs 17.7个月，P < 0.001）显著更长。与透析独立性相关的因素包括达到非常好的部分缓解（VGPR）、接受基于达雷妥尤单抗的方案、第一个化疗周期后血清游离轻链降低≥80%以及年龄<65岁。
在新药时代，依赖透析的MM预后仍然较差，尽管透析独立性可改善生存。
