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Does plasmapheresis have a role in the management of myeloma cast nephropathy?

Nature Clinical Practice Nephrology volume 2, pages 406–407 (2006)Cite this article

Impaired renal function is present in more than 20% of patients at the time of diagnosis of multiple myeloma.1,2 The degree of renal impairment is generally moderate, although a considerable proportion of patients have renal failure severe enough to require dialysis.1,3 In many instances, renal failure can be reversed—particularly when it is related to precipitating factors such as hypercalcemia, hyperuricemia, infections, or exposure to contrast material. Myeloma cast nephropathy, caused by precipitation of free monoclonal light chains within the renal tubules, with directly toxic consequences for the tubule epithelium, is the most common finding at renal biopsy.4,5,6 Renal failure is associated with poor patient prognosis, and recovery of renal function following therapy is associated with improved survival. Patient survival is, however, more a reflection of tumor burden and level of resistance to chemotherapy than renal function alone. Individuals with chemotherapy-resistant tumors fare poorly regardless of intervention.

Conventional chemotherapy for myeloma comprises melphalan plus prednisone or a combined regimen such as vincristine, doxorubicin and dexamethasone. The response rate for these approaches is 40–60% and median survival is 24–30 months.7 These figures can be improved further by dose intensification with autologous bone marrow or peripheral blood stem-cell support. Indeed, high-dose chemotherapy has become the standard treatment in newly diagnosed myeloma patients who are eligible for autologous stem-cell transplantation.7

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  1. Associate Professor in the Department of Medicine at the University of Montréal,

    François Madore

  2. Director of Clinical Research at the Research Center of Hôpital du Sacré-Coeur de Montréal, Montréal, QC, Canada

    François Madore

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  1. François Madore
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Correspondence to François Madore.

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Madore, F. Does plasmapheresis have a role in the management of myeloma cast nephropathy?. Nat Rev Nephrol 2, 406–407 (2006). https://doi.org/10.1038/ncpneph0229

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