title: [New insights in the treatment of myeloma with renal failure].
abstract: Renal failure, mostly related to myeloma cast nephropathy (MCN), is a frequent complication of multiple myeloma (MM), which occurs in up to 50% of patients during the course of the disease. Persistent renal failure in MM is associated with poor survival. Treatment of MCN relies on urgent symptomatic measures (alkalinisation, rehydration, correction of hypercalcemia, and withdrawal of nephrotoxic drugs), with rapid introduction of chemotherapy to efficiently reduce the production of monoclonal light chains (LC). Recent studies suggest that, in patients with MM and severe renal failure due to MCN, rapid removal of circulating LC, through intensive hemodialysis sessions using a new generation high cut-off dialysis membrane, might result in dialysis withdrawal in most patients. If the development of intensive therapy and new efficient chemotherapy agents (thalidomide, bortezomib, lenalidomide) has transformed the care and prognosis of MM, the modalities and safety of these therapeutic regimens in patients with renal failure remain to be defined. The association of bortezomib with dexamethasone should be considered currently as first-line treatment in patients with MM and impaired renal function.
authors.affiliation: Service de néphrologie, centre hospitalier de Niort, 79021 Niort, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Moumas
authors.forename: William
authors.initials: W
authors.lastname: Hanf
authors.forename: Estelle
authors.initials: E
authors.lastname: Desport
authors.forename: Julie
authors.initials: J
authors.lastname: Abraham
authors.forename: Sébastien
authors.initials: S
authors.lastname: Delbès
authors.forename: Céline
authors.initials: C
authors.lastname: Debiais
authors.forename: Laurence
authors.initials: L
authors.lastname: Lacotte-Thierry
authors.forename: Guy
authors.initials: G
authors.lastname: Touchard
authors.forename: Arnaud
authors.initials: A
authors.lastname: Jaccard
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Fermand
authors.forename: Frank
authors.initials: F
authors.lastname: Bridoux
mesh_terms: D020533:Angiogenesis Inhibitors / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001897:Boronic Acids / Q000008:administration & dosage / Q000627:therapeutic use; D000069286:Bortezomib; D002986:Clinical Trials as Topic; D000075202:Contraindications; D003520:Cyclophosphamide / Q000008:administration & dosage; D003907:Dexamethasone / Q000008:administration & dosage; D005440:Fluid Therapy; D006801:Humans; D006934:Hypercalcemia / Q000188:drug therapy / Q000209:etiology; D007147:Immunoglobulin Light Chains / Q000378:metabolism; D007676:Kidney Failure, Chronic / Q000209:etiology* / Q000378:metabolism / Q000628:therapy; D000077269:Lenalidomide; D008558:Melphalan / Q000008:administration & dosage; D015337:Multicenter Studies as Topic; D009101:Multiple Myeloma / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D009194:Myeloma Proteins / Q000378:metabolism; D011446:Prospective Studies; D011480:Protease Inhibitors / Q000627:therapeutic use; D011719:Pyrazines / Q000008:administration & dosage / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D006435:Renal Dialysis; D013792:Thalidomide / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D020533:Angiogenesis Inhibitors; D001897:Boronic Acids; D007147:Immunoglobulin Light Chains; D009194:Myeloma Proteins; D011480:Protease Inhibitors; D011719:Pyrazines; D013792:Thalidomide; D000069286:Bortezomib; D003907:Dexamethasone; D003520:Cyclophosphamide; D000077269:Lenalidomide; D008558:Melphalan