Pathogenesis and treatment of renal failure in multiple myeloma
TLDR
Clinical studies that have included newly diagnosed and refractory patients indicate that bortezomib-based regimens may result in rapid reversal of renal failure in up to 50% of patients and that full doses of bortzomib can be administered without additional toxicity.Abstract:
Renal failure is a frequent complication in patients with multiple myeloma (MM) that causes significant morbidity. In the majority of cases, renal impairment is caused by the accumulation and precipitation of light chains, which form casts in the distal tubules, resulting in renal obstruction. In addition, myeloma light chains are also directly toxic on proximal renal tubules, further adding to renal dysfunction. Adequate hydration, correction of hypercalcemia and hyperuricemia and antimyeloma therapy should be initiated promptly. Recovery of renal function has been reported in a significant proportion of patients treated with conventional chemotherapy, especially when high-dose dexamethasone is also used. Severe renal impairment and large amount of proteinuria are associated with a lower probability of renal recovery. Novel agents, such as thalidomide, bortezomib and lenalidomide, have significant activity in pretreated and untreated MM patients. Although there is limited experience with thalidomide and lenalidomide in patients with renal failure, data suggest that bortezomib may be beneficial in this population. Clinical studies that have included newly diagnosed and refractory patients indicate that bortezomib-based regimens may result in rapid reversal of renal failure in up to 50% of patients and that full doses of bortezomib can be administered without additional toxicity.read more
Citations
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Journal ArticleDOI
Renal Impairment in Patients With Multiple Myeloma: A Consensus Statement on Behalf of the International Myeloma Working Group
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,Jesús F. San Miguel +22 more
TL;DR: 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.
Journal ArticleDOI
European Myeloma Network Guidelines for the Management of Multiple Myeloma-related Complications
Evangelos Terpos,Martina Kleber,Monika Engelhardt,Sonja Zweegman,Efstathios Kastritis,Niels W.C.J. van de Donk,Benedetto Bruno,O. Sezer,Annemiek Broijl,Sara Bringhen,Meral Beksac,Alessandra Larocca,Roman Hájek,Pellegrino Musto,Hans Erik Johnsen,Fortunato Morabito,Heinz Ludwig,Michele Cavo,Hermann Einsele,Pieter Sonneveld,Meletios A. Dimopoulos,Antonio Palumbo +21 more
TL;DR: The European Myeloma Network provides recommendations for the management of the most common complications of multiple myeloma and Whole body low-dose computed tomography is more sensitive than conventional radiography in depicting osteolytic disease and thus it is recommended as the novel standard for the detection of lytic lesions in myelomas.
Journal ArticleDOI
International Myeloma Working Group Recommendations for the Diagnosis and Management of Myeloma-Related Renal Impairment
Meletios A. Dimopoulos,Pieter Sonneveld,Nelson Leung,Giampaolo Merlini,Heinz Ludwig,Efstathios Kastritis,Hartmut Goldschmidt,Douglas E. Joshua,Robert Z. Orlowski,R. L. Powles,David H. Vesole,Laurent Garderet,Hermann Einsele,Antonio Palumbo,Michele Cavo,Paul G. Richardson,Philippe Moreau,Jesus San Miguel,S. Vincent Rajkumar,B. Durie,Evangelos Terpos +20 more
TL;DR: Recommendations were based on published data through December 2015, and were developed using the system developed by the Grading of Recommendation, Assessment, Development, and Evaluation Working Group.
Journal ArticleDOI
Early Reduction of Serum-Free Light Chains Associates with Renal Recovery in Myeloma Kidney
Colin A. Hutchison,Paul Cockwell,Stephanie Stringer,Arthur R. Bradwell,Mark Cook,Morie A. Gertz,Angela Dispenzieri,Jeffrey L. Winters,Shaji Kumar,S. Vincent Rajkumar,Robert A. Kyle,Nelson Leung +11 more
TL;DR: Recovery of renal function in myeloma kidney depends on early reduction of serum FLCs, and this recovery associates with a significant survival advantage.
Journal ArticleDOI
International Myeloma Working Group recommendations for global myeloma care
Heinz Ludwig,J. S. Miguel,Meletios A. Dimopoulos,Antonio Palumbo,R. García Sanz,R. L. Powles,Suzanne Lentzsch,W Ming Chen,J. Hou,Artur Jurczyszyn,K Romeril,Roman Hájek,E. Terpos,K. Shimizu,Douglas E. Joshua,V. Hungria,A Rodriguez Morales,Dina Ben-Yehuda,Pia Sondergeld,Elena Zamagni,Brian G.M. Durie +20 more
TL;DR: The minimal requirements and possible options for diagnosis, monitoring and treatment of patients with multiple myeloma are proposed.
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