Renal impairment in patients with multiple myeloma: a consensus statement on behalf of the International Myeloma Working Group.

Abstract

Renal impairment is a common complication of multiple myeloma (MM). The estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease formula is the recommended method for the assessment of renal function in patients with MM with stabilized serum creatinine. In acute renal injury, the RIFLE (risk, injury, failure, loss and end-stage kidney disease) and Acute Renal Injury Network criteria seem to be appropriate to define the severity of renal impairment. Novel criteria based on eGFR measurements are recommended for the definition of the reversibility of renal impairment. Rapid intervention to reverse renal dysfunction is critical for the management of these patients, especially for those with light chain cast nephropathy. Bortezomib with high-dose dexamethasone is considered as the treatment of choice for such patients. There is limited experience with thalidomide in patients with myeloma with renal impairment. Thus, thalidomide can be carefully administered, mainly in the context of well-designed clinical trials, to evaluate if it can improve the rapidity and probability of response that is produced by the combination with bortezomib and high-dose dexamethasone. Lenalidomide is effective in this setting and can reverse renal insufficiency in a significant subset of patients, when it is given at reduced doses, according to renal function. The role of plasma exchange in patients with suspected light chain cast nephropathy and renal impairment is controversial. High-dose melphalan (140 mg/m(2)) and autologous stem-cell transplantation should be limited to younger patients with chemosensitive disease.

• Authors: Meletios A Dimopoulos, Evangelos Terpos, Asher Chanan-Khan, Nelson Leung, Heinz Ludwig, Sundar Jagannath, Ruben Niesvizky, Sergio Giralt, Jean-Paul Fermand, Joan Bladé, Raymond L Comenzo, Orhan Sezer, Antonio Palumbo, Jean-Luc Harousseau, Paul G Richardson, Bart Barlogie, Kenneth C Anderson, Pieter Sonneveld, Patrizia Tosi, Michele Cavo, S Vincent Rajkumar, Brian G M Durie, Jésus San Miguel
• Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology (J Clin Oncol) Vol. 28 Issue 33 Pg. 4976-84 (Nov 20 2010) ISSN: 1527-7755 [Electronic] United States
• PMID: 20956629 (Publication Type: Journal Article, Review)

Chemical References

• Boronic Acids
• Pyrazines
• Thalidomide
• Bortezomib
• Melphalan

Topics

• Boronic Acids (therapeutic use)
• Bortezomib
• Glomerular Filtration Rate
• Hematopoietic Stem Cell Transplantation
• Humans
• Incidence
• Melphalan (therapeutic use)
• Multiple Myeloma (complications, therapy)
• Prognosis
• Pyrazines (therapeutic use)
• Renal Insufficiency (epidemiology, etiology, therapy)
• Thalidomide (therapeutic use)
• Transplantation, Autologous