Managing renal complications in multiple myeloma

ABSTRACT

Introduction: About 20–40% of patients with multiple myeloma (MM) will present with some degree of renal impairment (RI) and about 25% of patients will experience RI at later disease stages. Patients with MM and RI have poorer overall survival and are at higher risk of early death.

Areas covered: The mechanisms of acute renal damage in MM are covered and the issues around diagnosis and renal evaluation response are discussed. The importance of optimal supportive care is stressed and the role and effectiveness of different anti-myeloma agents covered including the role of high cut-off hemodialysis, autologous stem cell transplantation and kidney transplant.

Expert commentary: Outcomes of patients with RI and rates of renal recovery have improved with the use of novel anti-myeloma agents. Bortezomib-dexamethasone backbone regimes (±third agent) are the current first choice in newly diagnosed patients. In relapsed/refractory disease additional treatment options include newer novel agents.

KEYWORDS:

• Multiple myeloma
• renal impairment
• myeloma cast nephropathy
• bortezomib
• IMiDs
• carfilzomib
• high-cut off hemodialysis

Declaration of interest

E Kastritis has received honoraria from Janssen, Takeda and Amgen. MA Dimopoulos has received honoraria from Celgene, Janssen, Takeda and Amgen. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This paper was not funded.