IMWG recommendations on the management of multiple myeloma-related renal impairment
The IMWG outline updates to clinical practice guidance for the management of multiple myeloma-related renal impairment. For patients with multiple myeloma and renal impairment, it is essential to measure serum creatinine, estimated glomerular filtration rate (eGFR), and free light chains (FLCs), alongside 24-hour urine total protein, electrophoresis, and immunofixation tests. If non-selective proteinuria (primarily albuminuria) or involved serum FLC values below 500 mg/L are detected, a renal biopsy should be performed. The IMWG’s criteria for renal response must be applied.
Supportive care, coupled with high-dose dexamethasone, is crucial for all individuals experiencing myeloma-related renal impairment, as mechanical interventions do not improve overall survival rates. Bortezomib-based regimens continue to be the mainstay of treatment for patients with both multiple myeloma and renal impairment.
Recent advances include new quadruplet and triplet combinations—featuring proteasome inhibitors, immunomodulatory agents, and anti-CD38 monoclonal antibodies—that enhance both renal function and survival outcomes in newly diagnosed and relapsed or refractory patients. Additionally, conjugated antibodies, chimeric antigen receptor (CAR) T-cells, and T-cell engagers have shown good tolerability and effectiveness in those with moderate renal impairment.
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