Actualités dans le traitement du myélome avec insuffisance rénale

Moumas, Eric; Hanf, William; Desport, Éstelle; Abraham, Julie; Delbès, Sébastien; Debiais, C.; Lacotte‐Thierry, Laurence; Touchard, Guy; Jaccard, Arnaud; Fermand, Jean‐Paul; Bridoux, Frank

doi:10.1016/j.nephro.2011.03.002

Cited by 3 publications

(4 citation statements)

References 48 publications

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“…However, we cannot exclude that the absence of significant difference between dialysis modalities could in part be due to low statistical power. Ongoing larger, randomized clinical trials in which bortezomib-based chemotherapy and extra-corporal light chain removal are used, like in our study, will formally answer the question [ 2 , 16 , 18 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

“…Nowadays, the treatment of myeloma cast nephropathy (MCN) relies on chemotherapy, mainly using bortezomib and dexamethasone [ 1 , 2 ]. In MCN, a hallmark of multiple myeloma (MM), serum immunoglobulin-free light chains (sFLC) produced by monoclonal plasma cells precipitate in renal tubules, resulting in tubular obstruction, local interstitial inflammation and ultimately kidney injury [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…Emerging data suggest the importance of extra-corporeal removal of monoclonal sFLC [ 5–9 ]. Indeed, in patients with MCN, the reduced glomerular filtration rate (GFR) delays sFLC clearance and this might worsen renal damage [ 2–4 , 10 ]. However, plasma exchange failed to show any clinical benefit in a large controlled and randomized clinical trial [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

“…Ongoing controlled and randomized trials are assessing the efficacy and safety of intensive haemodialysis (IHD) strategies with HCO membranes combined with bortezomib-based chemotherapy [ 2 , 16–18 ]. Moreover, data from in vitro studies suggest that poly(methyl methacrylate) (PMMA) membranes (BKF 2,1 Toray ® ) could also efficiently remove sFLC [ 12 , 19 ].…”

Section: Introductionmentioning

confidence: 99%

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Intensive haemodialysis using PMMA dialyser does not increase renal response rate in multiple myeloma patients with acute kidney injury

Hudier

Decaux

Haddj-Elmrabet

et al. 2017

Clinical Kidney Journal

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BackgroundIntensive haemodialysis (IHD) in addition to bortezomib-based chemotherapy might be efficient to rapidly decrease serum immunoglobulin-free light chains removal in patients with multiple myeloma (MM) and to improve renal prognosis and survival.MethodsThe aim of this retrospective multi-centre study was to compare the efficacy (renal recovery rate) of IHD and of standard haemodialysis (SHD) in patients with MM and dialysis-dependent acute kidney injury (AKI), concomitantly treated with bortezomib-based chemotherapy.ResultsWe selected 41 patients with MM and dialysis-dependent AKI, most likely due to myeloma cast nephropathy (MCN), and who were treated in eight French hospitals between January 2007 and June 2011. Patients were classified in two groups according to dialysis regimen: IHD [n = 21, with a mean of 11.3 dialysis sessions all with poly(methyl methacrylate) (PMMA) membranes for 13.2 days] and SHD (n = 20 patients, mostly three times per week, 31% with PMMA membrane). The main outcome was dialysis-independence at 3 months. At 3 months, 15 patients could stop dialysis: 8 (38.1%) in the IHD and 7 (35%) in the SHD group (P = 1). Moreover, 14 (56%) of the 25 patients who did show haematological response and only one of the 16 patients who did not were dialysis-independent (P = 0.002) at 3 months.ConclusionsThe results of this retrospective study did not show any clear renal benefit of IHD in patients with MM and MCN compared with SHD. Conversely, they underline the importance of the haematological response to chemotherapy for the renal response and patient prognosis.

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