Treatment of acute renal failure secondary to multiple myeloma with chemotherapy and extended high cut-off hemodialysis.

Research output: Contribution to journalArticle

Authors

  • Supratik Basu
  • S Harding
  • J Hattersley
  • ND Evans
  • MJ Chappel
  • P Sampson
  • Lukas Foggensteiner
  • Dwomoa Adu
  • Paul Cockwell

Abstract

BACKGROUND AND OBJECTIVES: Extended hemodialysis using a high cut-off dialyzer (HCO-HD) removes large quantities of free light chains in patients with multiple myeloma. However, the clinical utility of this method is uncertain. This study assessed the combination of chemotherapy and HCO-HD on serum free light chain concentrations and renal recovery in patients with myeloma kidney (cast nephropathy) and dialysis-dependent acute renal failure. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: An open-label study of the relationship between free light chain levels and clinical outcomes in 19 patients treated with standard chemotherapy regimens and HCO-HD. RESULTS: There were sustained early reductions in serum free light chain concentrations (median 85% [range 50 to 97]) in 13 patients. These 13 patients became dialysis independent at a median of 27 d (range 13 to 120). Six patients had chemotherapy interrupted because of early infections and did not achieve sustained early free light chain reductions; one of these patients recovered renal function (at 105 d) the remaining 5 patients did not recover renal function. Patients who recovered renal function had a significantly improved survival (P <0.012). CONCLUSION: In dialysis-dependent acute renal failure secondary to myeloma kidney, patients who received uninterrupted chemotherapy and extended HCO-HD had sustained reductions in serum free light chain concentrations and recovered independent renal function.

Details

Original languageEnglish
Pages (from-to)745-54
Number of pages10
JournalClinical Journal of the American Society of Nephrology
Volume4
Issue number4
Publication statusPublished - 1 Apr 2009