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Updated: Sep 24, 2025
An Organotypic High Throughput System for Characterization of Drug Sensitivity of Primary Multiple Myeloma Cells
Published on: July 15, 2015
Estimation of Kidney Function in Patients With Multiple Myeloma: Implications for Lenalidomide Dosing
Engie Salama1, Stepfanie Lam1, Wilson I Gonsalves2
1Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, USA.
Using Cockcroft-Gault with actual body weight (CGABW) is crucial for accurate lenalidomide dosing in multiple myeloma patients. Other methods risk under- or overdose, impacting patient safety and treatment efficacy.
Area of Science:
- Pharmacology
- Nephrology
- Oncology
Background:
- Lenalidomide, an immunomodulatory drug for multiple myeloma, requires precise renal dosing.
- Existing equations for estimating kidney function can lead to lenalidomide dosing errors.
Purpose of the Study:
- To evaluate the impact of different kidney function estimating equations on lenalidomide dosing in multiple myeloma.
- To compare Cockcroft-Gault (CG), MDRD, and CKD-EPI for lenalidomide dose calculation.
Main Methods:
- Creatinine clearance (CrCl) was calculated using CG with actual, ideal, or adjusted body weight, MDRD, and CKD-EPI in 1121 multiple myeloma patients.
- Dosing discrepancies were analyzed, and lenalidomide exposure was assessed.
Main Results:
- Approximately 16% of patients received a discordant lenalidomide dose when using MDRD or CKD-EPI instead of CGABW.
- The most common discordance involved a dose reduction from 25 mg to 10 mg.
- Discordant dosing posed risks of over- or underexposure, affecting lenalidomide pharmacokinetics.
Conclusions:
- Using MDRD or CKD-EPI instead of CGABW significantly increases the risk of incorrect lenalidomide dosing.
- Physicians should utilize CGABW for accurate renal function estimation and lenalidomide dosing.
- Accurate dosing is critical for optimizing lenalidomide's therapeutic effect and patient safety.
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