Multiple myeloma (MM) is a malignant plasma cell disorder that accounts for approximately 10% of all hematological malignancies. It is an incurable illness although survival has significantly improved in the last two decades. MM can affect kidneys in 20% to 40% of newly diagnosed patients and is one of the major determinants of survival of these patients.  Renal failure is the second leading cause of mortality in NDMM patients after infections and is often correlated with high tumor burden and advanced stage. Patients with RI at diagnosis have been reported to have a shorter time to next treatment (TTNT) after 1st line of therapy, increased risk of early mortality, and significantly inferior survival compared to patients presenting with normal renal function. Myeloma-related renal impairment can be reversed in more than 50% of patients with timely intervention. However, patients with low eGFR at presentation are likely to develop chronic kidney disease and whether improved renal function translates into improved survival remains a matter of debate. Patients with RI at presentation who recover their renal functions are more likely to develop RI in their disease course and therefore, require frequent monitoring.

The use of novel agents in the treatment of these patients has significantly improved their outcome in resource-rich countries, however, the data from resource-poor LMIC (Low and Middle-Income countries) is scarce. Various factors like advanced age, presence of high-risk cytogenetics, and poor hematological response to therapy have been identified as predictors of poor survival in these patients  but most of this data has been extrapolated from western studies. Likely, a different genetic profile, younger age at diagnosis, a lower proportion of asymptomatic patients, advanced stage at diagnosis, frequent over-the-counter use of analgesics, higher frequency of infections, and limited supportive care may contribute to inferior outcomes in MM-RI patients in LMIC.

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Mishita
Jornal co-ordinator
Journal of Clinical & Experimental Nephrology