An overview of treatment options for patients with relapsed/refractory multiple myeloma and renal impairment.

Renal impairment (RI) is a relatively common complication of multiple myeloma, which increases in frequency as disease becomes more advanced and recovery of renal function becomes less likely as patients progress through lines of therapy. Clinical trials in the relapsed/refractory multiple myeloma (RRMM) setting have not uniformly included patients with RI or robustly reported their outcomes. Here, we review existing data among patients with RI and RRMM across drug classes (including immunomodulatory agents, proteasome inhibitors, monoclonal antibodies, antibody-drug conjugates, chimeric antigen receptor T-cell therapies, and exportin-1 inhibitor) to provide an improved understanding of available treatment options for this important population. We highlight data from pivotal clinical trials, including data relating to renal response (as defined by the International Myeloma Working Group) and discuss real-world experiences in patients with RI, where applicable. Despite substantial advances in RRMM treatment, the presence of RI remains associated with reduced overall survival. Consistent inclusion of patients with RI, and uniform reporting of their outcomes, should be encouraged in future prospective trials of treatments for RRMM.
Competing Interests: Conflict of interest statement: The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: MAD reports honoraria from participation in Advisory Boards from Amgen, Beigene, Bristol Myers Squibb, Janssen, and Takeda. JM reports consulting fees from Amgen, Bristol Myers Squibb, Glaxo Smith Kline, Janssen, Karyopharm, and Sanofi and a leadership or fiduciary role in other board, society, committee, or advocacy group, paid or unpaid for the American Society of Hematology. ET reports research funding from Amgen, Celgene, Genesis, Glaxo Smith Kline, Janssen, Sanofi, and Takeda; and honoraria from Amgen, Bristol Myers Squibb, Celgene, Genesis, Glaxo Smith Kline, Janssen, Novartis, Sanofi, and Takeda. PM reports honoraria for Abbvie, Amgen, Celgene, Janssen, Sanofi, and Oncopeptides. JB reports honoraria from Amgen, Celgene, Janssen, Takeda, and Oncopeptides; and participation in other board, society, committee, or advocacy group, paid or unpaid for Karyopharm and Sanofi. KSG reports research funding from Caelum Biosciences, Ionis, Janssen, Sanofi and Takeda; and honoraria from GSK and Janssen. PGR reports research funding from Bristol Myers Squibb, Celgene, Karyopharm, Oncopeptides and Takeda; Participation on a Data Safety Monitoring Board or Advisory Board for AstraZeneca, Bristol Myers Squibb/Celgene, Glaxo Smith Kline, Janssen, Karyopharm, Oncopeptides, Protocol Intelligence, Regeneron, Sanofi, Secura Bio, and Takeda. XL and JSK have nothing to disclosure.
(© The Author(s), 2022.)