A Pilot Study of Plasma Exchange with Chemotherapy in Myeloma Cast Nephropathy
Renal failure is common in multiple myeloma (MM) and present in up to 50% of patients. It is most commonly related to myeloma cast nephropathy (MCN). Renal dysfunction in MM patients has a significant impact on patient survival with a median survival of less than a year in patients who remain dialysis- dependent. A study by Royal et al. showed a strong association between the renal recovery (best glomerular filtration rate (GFR)) and overall survival. MCN is caused by tubular damage induced by high concentrations of circulating serum free light chains (SFLC). A swift and efficient reduction of SFLC is paramount to mitigate permanent kidney damage and improve patient survival. Major efforts have been put into studying extracorporeal SFLC removal techniques, most commonly Therapeutic Plasma Exchange (TPE) or the treatment of MCN to improve patient outcomes and survival. Our internal experience suggests that TPE can improve renal outcomes. The role of TPE in the treatment of MCN however continues to be controversial due to inconsistent study results, study design flaws mostly mis-representative endpoints, suboptimal concomitant chemotherapy and low statistical power.
This project aims to study the effect of therapeutic plasma exchange in addition to standard of care plasma cell-directed therapy on renal outcomes in patients with MCN.