P-347: Renal Outcomes and Predictive Analysis of Progression in Newly Diagnosed Multiple Myeloma Patients

Introduction: Up to 50% of patients with multiple myeloma present with renal impairment (defined as estimated glomerular filtration rate [eGFR] < 40 mL/min per 1·73 m ² ) at the time of diagnosis, and 2–4% require dialysis. Renal impairment has been linked to decreased overall survival, increased risk of early death and a greater relative risk of myeloma progression for people with multiple myeloma as compared to those without renal impairment. The objective of this research is to investigate renal impairments in newly diagnosed multiple myeloma patients and the risk factors associated with it.

Methods: We conducted a retrospective analysis of 181 patients newly diagnosed with multiple myeloma at a tertiary medical center in India, from July 2022 to October 2023 . Patients with baseline serum creatinine 2 mg/dl or eGFR < 40ml/min by MDRD equation were defined to have renal insufficiency. Responses in renal function with treatment were graded according to IMWG criteria. Prognostic markers like age, comorbidities, baseline GFR, dialysis requirement, R-ISS stage, serum free light chains and treatment regimen used were analyzed in relation to renal outcomes

Results: A total of 181 patients were analyzed for the study among which 66.9% (N=121) were men and 31% (N=60) were female. The median age for the cohort was 55 years ( range: 30-85 ). 27.15% (N=45) of newly diagnosed multiple myeloma patients had renal impairment at baseline and 7.69% (N=14) required hemodialysis at baseline. 47.62% (N=21) among these patients had complete renal response, 4.76% (N=2) had partial response based on IMWG criteria. 14.29% (N=6) had minor response and 33.33% (N=15) had a further decline in renal function. Mortality at 1 year among patients with renal impairment was 79.17% (N=35) as compared to 20.83% (N=27) in patients without renal impairment at baseline.

39.63% (N=30) of patients with R-ISS III at presentation had renal impairment at baseline as compared to 5.88% (N=6) and 18.16% (N=9) patients with R-ISS I and II. 32.57% (N=32) and 10.81% (N=13) of patients with high risk and standard risk cytogenetics respectively had renal impairment at baseline.

In our study using a Random Forest model to predict renal outcomes in multiple myeloma patients, we achieved an accuracy of 86.57% and an ROC-AUC score of 92.99%. The model identified the most critical predictors of renal outcomes as serum free light chain ratio, baseline serum creatinine, and changes in creatinine levels, highlighting their importance in assessing renal function deterioration in this patient population.

Conclusions: Renal impairment was more prevalent in our cohort compared to previous studies and was associated with increased dialysis requirements. Additionally, mortality rates were higher among patients with more severe conditions. Treating these patients aggressively and early in the course of the disease is associated with better outcomes in terms of mortality and renal recovery.