Guideline for the diagnosis and management of multiple myeloma-related renal impairment (2024 version)

Renal impairment is a common complication of multiple myeloma (MM). All patients with MM should be assessed for the presence and severity of renal impairment. The clinicopathological manifestations of MM-related renal impairment are diverse and complex; accordingly, except for light-chain nephropathy, which can often be diagnosed without biopsy based solely on clinical criteria, a renal biopsy is needed for an accurate diagnosis. Supportive care, such as adequate hydration, is required for all patients with MM-related renal impairment. The guideline provide the principles for dose adjustment of the drugs used for MM with renal impairment, including proteasome inhibitors, immunomodulators, monoclonal antibodies, small molecule inhibitors, and alkylating agents, as well as those used for myeloma bone disease. Autologous stem cell transplantation (ASCT) and chimeric antigen receptor T-cell immunotherapy (CAR-T) are effective in patients with moderate renal impairment and are tolerated by the patients. The Chinese Hematology Association; the Chinese Geriatrics Association, Society of Hematology; and the Chinese Research Hospital Association, Society of Nephrology asked experts to collate information on current progress in clinical research relating to MM with renal impairment. This guideline was developed based on the gathered data combined with the latest international consensus and clinical practice guidelines.

肾损伤是多发性骨髓瘤（MM）的常见合并症。所有MM患者均应评估是否存在肾损伤及其严重程度。MM肾损伤临床病理表现复杂多样，轻链管型肾病在临床表现典型时一般不需肾活检即可诊断，余患者应尽可能行肾活检明确诊断。所有MM肾损伤患者应尽早给予水化等支持治疗。指南详细列出了治疗MM的主要药物在肾损害时的减量原则，包括蛋白酶体抑制剂、免疫调节剂、单克隆抗体、小分子抑制剂、烷化剂、抗骨病治疗药物等。自体造血干细胞移植（ASCT）及嵌合抗原受体T细胞免疫疗法（CAR-T）在中度肾损伤患者有较好的耐受性及有效性。中国医师协会血液科医师分会、中国老年医学学会血液学分会及中国研究型医院学会肾脏病学专委会组织专家检索MM合并肾损伤相关的最新临床研究进展，并结合国外最新指南、共识及临床实践制订了本指南。.