title: Treatment of acute renal failure secondary to multiple myeloma with chemotherapy and extended high cut-off hemodialysis.
abstract: OBJECTIVE
  Extended hemodialysis using a high cut-off dialyzer (HCO-HD) removes large quantities of free light chains in patients with multiple myeloma. However, the clinical utility of this method is uncertain. This study assessed the combination of chemotherapy and HCO-HD on serum free light chain concentrations and renal recovery in patients with myeloma kidney (cast nephropathy) and dialysis-dependent acute renal failure.
  
  
  METHODS
  An open-label study of the relationship between free light chain levels and clinical outcomes in 19 patients treated with standard chemotherapy regimens and HCO-HD.
  
  
  RESULTS
  There were sustained early reductions in serum free light chain concentrations (median 85% [range 50 to 97]) in 13 patients. These 13 patients became dialysis independent at a median of 27 d (range 13 to 120). Six patients had chemotherapy interrupted because of early infections and did not achieve sustained early free light chain reductions; one of these patients recovered renal function (at 105 d) the remaining 5 patients did not recover renal function. Patients who recovered renal function had a significantly improved survival (P < 0.012).
  
  
  CONCLUSIONS
  In dialysis-dependent acute renal failure secondary to myeloma kidney, patients who received uninterrupted chemotherapy and extended HCO-HD had sustained reductions in serum free light chain concentrations and recovered independent renal function.
authors.affiliation: Department of Nephrology, Queen Elizabeth Hospital, Birmingham, United Kingdom. c.a.hutchison@bham.ac.uk
authors.forename: Colin A
authors.initials: CA
authors.lastname: Hutchison
authors.forename: Arthur R
authors.initials: AR
authors.lastname: Bradwell
authors.forename: Mark
authors.initials: M
authors.lastname: Cook
authors.forename: Kolitha
authors.initials: K
authors.lastname: Basnayake
authors.forename: Supratik
authors.initials: S
authors.lastname: Basu
authors.forename: Stephen
authors.initials: S
authors.lastname: Harding
authors.forename: John
authors.initials: J
authors.lastname: Hattersley
authors.forename: Neil D
authors.initials: ND
authors.lastname: Evans
authors.forename: Mike J
authors.initials: MJ
authors.lastname: Chappel
authors.forename: Paul
authors.initials: P
authors.lastname: Sampson
authors.forename: Lukas
authors.initials: L
authors.lastname: Foggensteiner
authors.forename: Dwomoa
authors.initials: D
authors.lastname: Adu
authors.forename: Paul
authors.initials: P
authors.lastname: Cockwell