EARLY APPLICATION OF HIGH CUT-OFF HAEMODYALISIS FOR DE-NOVO MYELOMA NEPHROPATHY IS ASSOCIATED WITH LONG-TERM DIALYSIS-INDEPENDENCY AND RENAL RECOVERY
EARLY APPLICATION OF HIGH CUT-OFF HAEMODYALISIS FOR DE-NOVO MYELOMA NEPHROPATHY IS ASSOCIATED WITH LONG-TERM DIALYSIS-INDEPENDENCY AND RENAL RECOVERY
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Background Multiple myeloma (MM) is a haematological malignancy associated with kidney injury resulting from cast nephropathy, which can be caused by monoclonal free light chains (FLC).It has been demonstrated that reduction of FLC can lead to a higher proportion of patients recovering renal function with a better outcome, especially if extended high cut-off haemodialysis (HCO-HD) combined with chemotherapy is used.Patients and Methods In this study, four cases of MM nephropathy were treated with HCO-HD and chemotherapy at a single institution during the period from August 2009 to August 2011.All of the patients presented with acute renal failure and high serum FLC.
All patients underwent a bone marrow biopsy to confirm the diagnosis of MM, custom congratulations banner according to the WHO criteria.Three patients had de-novo MM and one patient had relapsed light chain myeloma disease.All patients underwent HCO-HD concomitantly with specific myeloma therapy once the diagnosis or relapse of MM was established.Results After a median follow up of 26 months, (range, 13-36) our data showed that all patients had a significant decrease in serum FLC through HCO-HD, proving the effectiveness of HCO-HD in managing MM.
De-novo MM patients restored their renal function and achieved ventilationstejp low-level FLC early on the treatment and become dialysis-independent.One patient with relapsed myeloma remained dialysis dependant.Conclusion Our study suggests that if myeloma nephropathy associated with light-chain disease, HCO-HD should be initiated as early as possible.At the same time a specific MM treatment should be initiated to gain control of the disease and salvage the kidneys in order to achieve dialysis-independency.
Further trials to confirm our results are warranted.Key Words: Multiple myeloma, renal failure, High cut-off haemodialysis, chemotherapy, outcome.