Autologous Transplantation Deepens Responses in Dialysis-Dependent Multiple Myeloma
By: Lisa Astor
Posted: Monday, September 14, 2026
Autologous stem cell transplantation (ASCT) proved feasible and markedly deepened treatment responses in transplant-eligible patients with newly diagnosed multiple myeloma who remained dependent on dialysis, according to a multicenter retrospective study published in Cancer Research and Treatment. However, an apparent survival benefit weakened after adjustment for the timing of transplantation.
The study authors, including co-corresponding author Sung-Hoon Hung, MD, PhD, of Chonnam National University Hwasun Hospital, and Kihyun Kim, MD, of Samsung Medical Center, Sungkyunkwan University School of Medicine, both in Korea, characterized their findings as “hypothesis-generating, warranting confirmation in prospective studies.”
Approximately 2% to 3% of patients with multiple myeloma present at diagnosis with renal failure severe enough to require dialysis. This population has historically been largely excluded from pivotal transplant trials. To help clarify the role of ASCT in this setting, researchers analyzed 117 patients with dialysis-dependent multiple myeloma who were treated at 13 Korean centers between 2001 and 2022, all of whom remained on dialysis throughout induction therapy. Of these, 55 underwent ASCT, more than half with reduced-intensity melphalan conditioning.
Although post-induction response rates were similar between the groups, ASCT substantially deepened responses. Among 53 paired-evaluable patients, the rate of complete response or better rose from 18.9% before ASCT to 60.4% afterward, and the rate of very good partial response or better rose from 52.8% to 83%. In analyses anchored at diagnosis, median progression-free survival was 39.4 months with ASCT vs 12.1 months without (P < .001), and median overall survival was 71.4 vs 40.3 months (P = .020). When ASCT was modeled as a time-dependent covariate to account for immortal time bias, however, neither endpoint remained statistically significant. In a propensity score–matched comparison, the progression-free survival advantage persisted, but the overall survival difference did not.
The transplant procedure appeared tolerable, with early post-transplant mortality of 5.5% and nonrelapse mortality of 3.6%. Durable discontinuation of dialysis was achieved by 16.4% of ASCT recipients and 12.9% of the non-ASCT group. The authors concluded that ASCT is a viable option for carefully selected patients with dialysis-dependent disease.
Disclosure: The study authors reported no relevant conflicts of interest.
