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<p>Severe renal impairment (RI) is a major contributor to early morbidity and mortality in transplant-ineligible newly diagnosed multiple myeloma (Ti-NDMM). Although daratumumab, lenalidomide, and dexamethasone (DRd) is an established frontline regimen, patients with creatinine clearance ≤ 30&#xa0;mL/min were excluded from the MAIA trial, leaving evidence in this high-risk population limited. We retrospectively analyzed Ti-NDMM patients with severe RI, defined as estimated glomerular filtration rate (eGFR) ≤ 30&#xa0;mL/min/1.73 m<sup>2</sup>, treated with frontline DRd between 2019 and 2024 at our institution. Ten patients met inclusion criteria, all classified as stage III according to the Second Revision of the International Staging System. The overall hematologic response rate was 80%, including very good partial response or better in 50%. Complete renal response occurred in 40% and was associated with deeper hematologic response and significantly prolonged progression-free survival and time to next treatment. Median eGFR improved from 21 to 50.5&#xa0;mL/min/1.73 m<sup>2</sup>. These findings suggest that DRd is feasible and may provide clinically meaningful renal recovery and disease control in Ti-NDMM patients with severe RI, supporting its potential role as a frontline therapeutic option in this underrepresented population.</p>

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Renal recovery and clinical outcomes with daratumumab, lenalidomide, and dexamethasone in transplant-ineligible newly diagnosed multiple myeloma with severe renal impairment

  • 期刊论文

  • 发表日期：

    2026年3月30日

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  • Yuichi Horigome,
  • Hirotoshi Kamata,
  • Koichi Ehata,
  • Noriyuki Tadera,
  • Kei Hayama,
  • Takahiro Suzuki

摘要

Severe renal impairment (RI) is a major contributor to early morbidity and mortality in transplant-ineligible newly diagnosed multiple myeloma (Ti-NDMM). Although daratumumab, lenalidomide, and dexamethasone (DRd) is an established frontline regimen, patients with creatinine clearance ≤ 30 mL/min were excluded from the MAIA trial, leaving evidence in this high-risk population limited. We retrospectively analyzed Ti-NDMM patients with severe RI, defined as estimated glomerular filtration rate (eGFR) ≤ 30 mL/min/1.73 m2, treated with frontline DRd between 2019 and 2024 at our institution. Ten patients met inclusion criteria, all classified as stage III according to the Second Revision of the International Staging System. The overall hematologic response rate was 80%, including very good partial response or better in 50%. Complete renal response occurred in 40% and was associated with deeper hematologic response and significantly prolonged progression-free survival and time to next treatment. Median eGFR improved from 21 to 50.5 mL/min/1.73 m2. These findings suggest that DRd is feasible and may provide clinically meaningful renal recovery and disease control in Ti-NDMM patients with severe RI, supporting its potential role as a frontline therapeutic option in this underrepresented population.