Plasma Exchange in Rapidly Progressive Renal Failure Due to Multiple Myeloma

Abstract

Background/Aims: To evaluate the effect of plasma exchange on renal function in patients with rapidly progressive renal failure secondary to multiple myeloma. Methods: The study was done through a retrospective chart review using a standardized form at a tertiary care centre in southwestern Ontario. Patients were included in the study if they had a diagnosis of multiple myeloma and rapidly progressive renal failure. Multiple myeloma was defined by a bone marrow aspirate >15% plasma cells plus one of the following: serum monoclonal paraproteins, monoclonal light-chain excretion, or lytic lesions. Patients were excluded if they had evidence of chronic renal failure or failed to complete three plasma exchanges. Twenty-six patients were reviewed; of these 24 were followed up to 1 year. All patients received hydration, standard chemotherapy, and plasma exchange. The plasma exchange volume was 50 ml/kg of 50% normal saline and 50% human serum albumin. Primary outcome measures included (1) prevention of acute dialysis and (2) prevention of progression from acute to chronic dialysis; secondary end points included (1) a decrease in creatinine of 25% or more within 3 months of the last plasma exchange and (2) survival at 1 year. Results: Sixteen of 24 patients, followed up to 1 year, did not require dialysis. Two patients required dialysis initially, but were able to come off dialysis after 3 months. Fourteen patients were alive at 1 year, 13 of whom were dialysis independent. Twelve of 13 dialysis-independent patients had a >25% reduction in creatinine at 3 months. Two patients were lost to follow-up after discharge and were not included in the analysis. Conclusions: This retrospective study suggests that plasma exchange may offer some benefit in preventing the initiation or continuation of dialysis in patients with rapidly progressive renal failure secondary to multiple myeloma. A randomized controlled prospective study is needed to determine whether plasma exchange should be recommended as a standard treatment for patients with rapidly progressive renal failure due to multiple myeloma.

Onco-Nephrology

“…Given the established role of myeloma light chains in causing renal injury, the clinical benefit of using plasmapheresis to reduce the burden of light chains has been investigated in several studies, including three randomized controlled trials (RCTs) (30)(31)(32)(33)(34)(35)(36)(37). One of these RCTs showed a survival benefit and improved renal function in the plasmapheresis group; however, patients in the plasmapheresis group received hemodialysis, whereas those patients in the control group received peritoneal dialysis (31).…”

Safety and efficacy of autologous hemopoietic progenitor cell collection in tandem with hemodialysis in multiple myeloma with myeloma cast nephropathy

“…In 2003 the Scientific Advisors of the International Myeloma Foundation declared, based on a series of small trials [19][20][21][22] that, in addition to other treatments, plasma exchange can ". .…”

Clinical Features of Renal Insufficiency due to Multiple Myeloma and Related Risk Factors

“…Third, a large number of these patients did not receive plasma exchange or dialysis. It has been suggested that rapid removal of light chains with chemotherapy and plasmapheresis could prevent irreversible renal insufficiency [6] .…”