MULTIPLE myeloma ICU survival has improved in recent years, with better adjusted one year outcomes despite greater illness severity at admission.
Patients with multiple myeloma requiring intensive care are experiencing improved survival, according to a retrospective cohort analysis spanning 17 years. Investigators compared outcomes for 428 adults admitted to a single intensive care unit between 2007 and 2023, evaluating whether advances in myeloma treatment and critical care translated into better short and long term outcomes.
Multiple Myeloma ICU Survival Improved Despite Greater Severity
The study included 199 patients admitted between 2007 and 2015 and 229 patients admitted from 2016 through 2023. Although patients in the more recent period presented with higher Sequential Organ Failure Assessment scores, reflecting more severe acute illness, adjusted one year mortality was significantly lower than during the earlier period. The adjusted hazard ratio for one year mortality was 0.68, indicating a meaningful survival improvement after accounting for age, comorbidities, disease burden, treatment history, timing of ICU admission, and illness severity.
Overall ICU mortality was 12.1%, hospital mortality reached 21.7%, and one year mortality was 40.6%. Acute respiratory failure remained the most common reason for ICU admission, although admissions for shock became more frequent during the later study period. More than one quarter of patients required invasive mechanical ventilation, while approximately one quarter received vasopressors or renal replacement therapy during their ICU stay.
Risk Factors for Poorer Outcomes
Among patients admitted between 2016 and 2023, two factors independently predicted higher one year mortality. Receiving more than two previous lines of multiple myeloma treatment before ICU admission increased mortality risk by 77%, while each increase in SOFA score was also associated with worse survival. Age, diabetes, and poorer performance status were not independently associated with mortality after multivariable adjustment.
The investigators also observed that high risk cytogenetic disease did not independently influence short term ICU survival in the contemporary treatment era, suggesting these features alone should not determine decisions regarding ICU admission.
Implications for Critical Care
The findings suggest that advances in intensive care and modern multiple myeloma management have contributed to improved outcomes, even among patients presenting with more severe critical illness. The authors conclude that patients who have not undergone extensive prior treatment appear most likely to benefit from intensive care and emphasize the importance of early ICU referral alongside close collaboration between haematologists and intensivists when managing this high risk population. They note that the retrospective, single center design and lack of long term functional outcome data remain important study limitations.
Reference
Nakaa S et al. Improved survival in patients admitted to ICU with multiple myeloma: a retrospective cohort analysis. Annals of Intensive Care. 2026;16:100100.
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