Multiple myeloma in end-stage renal disease
1Division of Nephrology, VA North Texas Health Care System and University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75216, USA. Jeffrey.Penfield@med.va.gov
Seminars in Dialysis
|August 9, 2006
Summary
Multiple myeloma frequently causes chronic kidney disease (CKD). Early treatment with high-dose melphalan and stem cell transplant can improve kidney function, even in dialysis patients.
Area of Science:
- Nephrology
- Hematology
- Oncology
Background:
- Multiple myeloma is a significant cause of chronic kidney disease (CKD).
- Renal disease in myeloma is linked to specific secreted light chains.
- Simplified diagnostic criteria exist for symptomatic myeloma with kidney involvement.
Purpose of the Study:
- To review current understanding of myeloma-related kidney disease.
- To discuss the impact of novel therapies on renal function in multiple myeloma.
- To outline treatment strategies for multiple myeloma patients with CKD.
Main Methods:
- Literature review of recent advancements in multiple myeloma treatment and renal complications.
- Analysis of therapeutic strategies including thalidomide, bisphosphonates, and stem cell transplantation.
- Discussion of renal transplantation and dialysis in advanced disease.
Main Results:
- Thalidomide and bisphosphonates require cautious use in CKD patients due to potential side effects.
- High-dose melphalan with autologous stem cell transplant is the standard of care and can improve renal disease.
- Early intervention with stem cell transplant offers better renal outcomes.
Conclusions:
- Myeloma-related kidney disease necessitates careful management of therapies.
- Stem cell transplantation is a viable and beneficial treatment option for myeloma patients with CKD, including those on dialysis.
- Renal transplantation may be considered for patients achieving complete remission and requiring ongoing dialysis.
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