title: Immunoglobulin free light chain levels and recovery from myeloma kidney on treatment with chemotherapy and high cut-off haemodialysis.
abstract: BACKGROUND
  To determine the efficacy of immunoglobulin free light chain (FLC) removal by high cut-off haemodialysis (HCO-HD) as an adjuvant treatment to chemotherapy for patients with acute kidney injury complicating multiple myeloma (MM).
  
  
  METHODS
  Sixty-seven patients with dialysis-dependent renal failure secondary to MM were treated with HCO-HD and chemotherapy.
  
  
  RESULTS
  The population was predominantly male (62.7%) with new presentation MM (75%) and did not have a history of chronic kidney disease (84%). The mean serum creatinine at presentation was 662 (SD = 349) μmol/L and of the 56.7% of patients who had a renal biopsy, 86.7% had cast nephropathy as the principal diagnosis. Eighty-five percent of patients were treated with a chemotherapy regime consisting of dexamethasone in combination with a novel agent (bortezomib or thalidomide). The median number of HCO-HD sessions was 11 (range 3-45), 97% received an extended dialysis regime. Seventy-six percent of the population had a sustained reduction in serum FLC concentrations by Day 12, of these 71% subsequently became independent of dialysis. In total, 63% of population became independent of dialysis. Factors which predicted independence of dialysis were the degree of FLC reduction at Days 12 (P = 0.002) and 21 (P = 0.005) and the time to initiating HCO-HD (P = 0.006).
  
  
  CONCLUSIONS
  The combination of extended HCO-HD and chemotherapy resulted in sustained reductions in serum FLC concentrations in the majority of patients and a high rate of independence of dialysis.
authors.affiliation: University of Birmingham, Birmingham, UK. c.a.hutchison@bham.ac.uk
authors.forename: Colin A
authors.initials: CA
authors.lastname: Hutchison
authors.forename: Nils
authors.initials: N
authors.lastname: Heyne
authors.forename: Parisa
authors.initials: P
authors.lastname: Airia
authors.forename: Ralf
authors.initials: R
authors.lastname: Schindler
authors.forename: Daniel
authors.initials: D
authors.lastname: Zickler
authors.forename: Mark
authors.initials: M
authors.lastname: Cook
authors.forename: Paul
authors.initials: P
authors.lastname: Cockwell
authors.forename: Daniel
authors.initials: D
authors.lastname: Grima
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology* / Q000276:immunology / Q000628:therapy*; D000368:Aged; D001897:Boronic Acids / Q000008:administration & dosage; D000069286:Bortezomib; D003131:Combined Modality Therapy; D016208:Databases, Factual; D003907:Dexamethasone / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007147:Immunoglobulin Light Chains / Q000097:blood* / Q000302:isolation & purification; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications* / Q000276:immunology / Q000628:therapy*; D011719:Pyrazines / Q000008:administration & dosage; D006435:Renal Dialysis / Q000379:methods*; D013792:Thalidomide / Q000008:administration & dosage
chemical_list: D001897:Boronic Acids; D007147:Immunoglobulin Light Chains; D011719:Pyrazines; D013792:Thalidomide; D000069286:Bortezomib; D003907:Dexamethasone