Abstract:  Multiple myeloma (MM) is associated with a high incidence of renal impairment (RI), which correlates
with decreased overall survival and increased risk of early mortality in these patients. In recent years, there has been great progress in the treatment of MM, with new drugs and therapies improving prognosis. However, the prognosis for patients with concurrent RI remains poorer compared to those with normal renal function. This article reviews the advancements in treatment and relevant strategies for MM patients with RI.. Current research supports the combined use of monoclonal antibodies with proteasome inhibitors or immunomodulatory drugs in these patients. Chimeric antigen receptor (CAR) T cells therapy，T⁃cell directing bispecific antibodies and antibody⁃drug conjugates have only been evaluated in small⁃scale retrospective studies for use in patients with RI. Although the benefits of mechanical approaches aimed at rapid clearance of free light chains，such as plasmapheresis and high⁃cutoff hemodialysis, have yet to be confirmed, they may provide opportunities for renal recovery when combined with chemotherapy. Future randomized controlled trials (RCTs) should proactively assess the efficacy and safety of treatments in patients with renal impairment.

Key words: Combination therapy, Anti-myeloma therapy, Extracorporeal free light chain removal