title: Evaluation of blood purification and bortezomib plus dexamethasone therapy for the treatment of acute renal failure due to myeloma cast nephropathy.
abstract: Aggressive removal of circulating free light chains (FLC) by blood purification accompanied by chemotherapy is a promising approach for the treatment of acute renal failure due to myeloma cast nephropathy. Plasma exchange has been performed to remove serum FLC; in order to examine an alternative strategy we performed hemodiafiltration using protein-leaking dialyzers for the treatment of dialysis-dependent acute renal failure due to myeloma cast nephropathy. In the first case with κ-light chain cast nephropathy, the pre-treatment serum creatinine was 9.65 mg/dL, and the serum κ-FLC was 27100 mg/L. Plasma exchange or hemodiafiltration was performed from Monday to Friday during the first several weeks. Chemotherapy was started with high-dose dexamethasone and then switched to bortezomib plus dexamethasone. The mean removal rates of κ-FLC were 45.8% (one plasma volume) and 66.9% (one-and-a-half plasma volumes) by plasma exchange. The removal rates of κ-FLC by hemodiafiltration (66.9%, FB210UHβ; 71.6%, PES210Dα; 75.2%, FXS220) were comparable to those by plasma exchange. In the second case with λ-light chain cast nephropathy, the pre-treatment serum creatinine was 4.14 mg/dL, and the serum λ-FLC was 4140 mg/L. The mean removal rates of λ-FLC were 60.2% (FXS140) and 64.2% (FB210UHβ) by hemodiafiltration. Both cases became dialysis-independent. The combination of an intense blood purification regimen and bortezomib plus dexamethasone therapy appears to be an efficient approach to renal recovery. Hemodiafiltration using protein-leaking dialyzers could become an alternative to plasma exchange as a method of removing FLC.
authors.affiliation: Departments of Nephrology Hematology Joint Research Laboratory of Clinical Medicine, Fujita Health University School of Medicine Laboratory of Clinical Medicine, Toyoachi, Aichi, Japan. mhase@fujita-hu.ac.jp
authors.forename: Midori
authors.initials: M
authors.lastname: Hasegawa
authors.forename: Fumiko
authors.initials: F
authors.lastname: Kondo
authors.forename: Koichiro
authors.initials: K
authors.lastname: Yamamoto
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Murakami
authors.forename: Makoto
authors.initials: M
authors.lastname: Tomita
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Nabeshima
authors.forename: Shigeru
authors.initials: S
authors.lastname: Nakai
authors.forename: Masao
authors.initials: M
authors.lastname: Kato
authors.forename: Atsushi
authors.initials: A
authors.lastname: Ohashi
authors.forename: Jiro
authors.initials: J
authors.lastname: Arai
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Hiki
authors.forename: Junichi
authors.initials: J
authors.lastname: Ishii
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Emi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Sugiyama
authors.forename: Yukio
authors.initials: Y
authors.lastname: Yuzawa
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology / Q000628:therapy*; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001897:Boronic Acids / Q000008:administration & dosage; D000069286:Bortezomib; D003131:Combined Modality Therapy; D003907:Dexamethasone / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D005260:Female; D017583:Hemodiafiltration / Q000379:methods*; D006801:Humans; D007147:Immunoglobulin Light Chains / Q000097:blood; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications; D010951:Plasma Exchange / Q000379:methods*; D011719:Pyrazines / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D001897:Boronic Acids; D007147:Immunoglobulin Light Chains; D011719:Pyrazines; D000069286:Bortezomib; D003907:Dexamethasone