Early mortality in multiple myeloma patients with renal impairment: a nested case-control study

Background Renal impairment (RI) in multiple myeloma (MM) patients significantly impacts outcomes, yet the prevalence and causes of early mortality within 12 months of diagnosis in newly diagnosed MM (NDMM) with RI are understudied in the novel agent era. Methods This study conducted a nested case-control analysis including 199 NDMM patients with RI from West China Hospital from June 2016 to November 2022, we identified 19 cases of early mortality and selected 76 matched controls based on age, gender, and diagnosis date at a 1:4 ratio. All controls were followed for over one year. Potential risk factors including elevated N-terminal pro-brain natriuretic peptide (NT-proBNP), heart failure at diagnosis, and other clinical indicators were analyzed. Results The incidence of early death was determined to be 9.5% in MM with RI, with pneumonia as the leading cause. Compared to controls, the case group exhibited a higher prevalence of elevated lactate dehydrogenase (LDH) levels and pneumonia. Multivariable logistic regression identified elevated LDH levels (OR 9.09, 95% CI 1.476–55.971) and pneumonia at diagnosis as independent risk factors for early mortality, whereas NT-proBNP elevation and heart failure at onset did not show statistically significant associations. The 1-year overall survival rates for MM with RI were 95.3% with 0 risk factors, 85.2% with 1 risk factor, and 68.8% with 2 risk factors ( p  < 0.001). Conclusions In this nested case-control study, elevated LDH levels and pneumonia at diagnosis were identified as independent risk factors for early mortality in NDMM patients with renal impairment.