Managing renal complications in multiple myeloma
Despoina Fotiou1, Meletios A Dimopoulos1, Efstathios Kastritis1
1a Department of Clinical Therapeutics , National and Kapodistrian University of Athens, School of Medicine , Athens , Greece.
Expert Review of Hematology
|July 19, 2016
Summary
Multiple myeloma (MM) patients with renal impairment (RI) face poorer survival. Novel therapies and supportive care are improving outcomes and renal recovery for these patients.
Area of Science:
- Hematology
- Nephrology
- Oncology
Background:
- 20-40% of multiple myeloma (MM) patients present with renal impairment (RI).
- RI in MM patients is associated with poorer overall survival and increased risk of early mortality.
- Approximately 25% of MM patients develop RI during later disease stages.
Purpose of the Study:
- To review mechanisms of acute renal damage in MM.
- To discuss diagnosis and response evaluation for renal complications in MM.
- To highlight the importance of supportive care and novel anti-myeloma agents in managing MM-associated RI.
Main Methods:
- Review of mechanisms of acute renal damage in multiple myeloma.
- Discussion of diagnostic criteria and response assessment for renal involvement.
- Evaluation of treatment strategies including supportive care, hemodialysis, stem cell transplantation, and kidney transplant.
- Analysis of the role and efficacy of various anti-myeloma agents.
Main Results:
- Outcomes for MM patients with RI have improved.
- Renal recovery rates have increased with the use of novel anti-myeloma agents.
- Bortezomib-dexamethasone regimens are a first-line choice for newly diagnosed MM patients with RI.
- Newer agents offer additional treatment options for relapsed/refractory MM with RI.
Conclusions:
- Optimal supportive care and novel anti-myeloma therapies enhance renal recovery in MM patients.
- Current treatment paradigms focus on bortezomib-based regimens for initial therapy.
- Advanced treatment options are available for relapsed or refractory MM with renal complications.
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