Treatment of acute renal failure secondary to multiple myeloma with chemotherapy and extended high cut-off hemodialysis.
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.
Hutchison
Colin A
CA
Department of Nephrology, Queen Elizabeth Hospital, Birmingham, United Kingdom. c.a.hutchison@bham.ac.uk
Bradwell
Arthur R
AR
Cook
Mark
M
Basnayake
Kolitha
K
Basu
Supratik
S
Harding
Stephen
S
Hattersley
John
J
Evans
Neil D
ND
Chappel
Mike J
MJ
Sampson
Paul
P
Foggensteiner
Lukas
L
Adu
Dwomoa
D
Cockwell
Paul
P