Autologous Hematopoietic Stem Cell Transplantation in Multiple Myeloma Complicated by Dialysis-Dependent Renal Failure

BACKGROUND. Renal failures, among them dialysis-dependent kidney disease, are common complications of multiple myeloma (ММ). Hemodialysis (HD) independence is achieved in only 20 % of standard induction therapy recipients. The survival of program HD patients remains unsatisfactory. Autologous hematopoietic stem cell transplantation (auto-HSCT) is usually planned and performed in young MM patients. However, the program HD patients are often excluded from the high-dose chemotherapy protocols with subsequent auto-HSCT due to the therapy associated toxicity risk. AIM. To assess the efficacy and safety of auto-HSCT in MM complicated by dialysis-dependent renal failure. MATERIALS & METHODS. In the period from 2015 to 2022, 14 program HD patients (8 men and 6 women) received auto-HSCT at the City Clinical Hospital No. 52. The median age was 53 years (range 43–66 years). In two patients, tandem transplantation was performed. Melphalan 140 mg/m2 (n = 10) was administered for pre-transplant conditioning. In 4 patients, bendamustine 200 mg/m2 was added to melphalan in the conditioning regimen. The median transfused СD34+ cell count was 3.61 × 106/kg (range 1.34–9.69 × 106/kg). By the time of completing bortezomib and/or lenalidomide induction therapy, complete remission (CR) was achieved in 5 patients, other 5 patients showed very good partial remission (VGPR), and in 4 patients partial remission (PR) was registered. RESULTS. As reported by the control follow-up on Day +100 after auto-HSCT, all patients demonstrated further deepening of antitumor response. By this time, CR in 11 (79 %) patients and VGPR in 2 (14 %) patients were registered, whereas 1 (7 %) patient maintained PR. Renal response and HD independence were achieved in 8 (57 %) out of 14 patients enrolled in the trial. In the total group (n = 14), the 3-year event-free survival was 50 % and overall survival was 78 %. CONCLUSION. Dialysis-dependent renal failure in MM patients is no contraindication to auto-HSCT. The latter will improve chemotherapy outcomes and make it possible to achieve renal response and HD independence.