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Review
. 2023 Mar 29;13(1):46.
doi: 10.1038/s41408-023-00806-w.

Multiple myeloma with acute light chain cast nephropathy

Nelson Leung  1   2 , S Vincent Rajkumar  3
Affiliations
Review

Multiple myeloma with acute light chain cast nephropathy

Nelson Leung et al. Blood Cancer J. .

Abstract

Light chain cast nephropathy (LCCN) is a leading cause of acute kidney injury (AKI) in patients with multiple myeloma (MM) and is now defined as a myeloma defining event. While the long-term prognosis has improved with novel agents, short-term mortality remains significantly higher in patients with LCCN especially if the renal failure is not reversed. Recovery of renal function requires a rapid and significant reduction of the involved serum free light chain. Therefore, proper treatment of these patients is of the utmost importance. In this paper, we provide an algorithm for treatment of MM patients who present with biopsy-proven LCCN or in those where other causes of AKI have been ruled out. The algorithm is based on data from randomized trial whenever possible. When trial data is not available, our recommendations is based on non-randomized data and expert opinions on best practices. We recommend that all patients should enroll in a clinical trial if available prior to resorting to the treatment algorithm we outlined.

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Conflict of interest statement

Dr NL reports Stock and Other Ownership Interests at Senseonics, AbbVie, Verrica, and research funding from Omeros, all outside the submitted work. Dr SVR reports grants from NIH, outside the submitted work.

Figures

Fig. 1
Fig. 1. Treatment algorithm for newly diagnosed multiple myeloma patients with acute kidney injury.
AKI acute kidney injury, FLC free light chains, M monoclonal, LCCN light chain cast nephropathy, VCD bortezomib, cyclophosphamide, dexamethasone, VTD bortezomib, thalidomide, dexamethasone, PLEX plasma exchange.
See this image and copyright information in PMC

References

    1. Knudsen LM, Hippe E, Hjorth M, Holmberg E, Westin J. Renal function in newly diagnosed multiple myeloma—a demographic study of 1353 patients. The Nordic Myeloma Study Group. Eur J Haematol. 1994;53:207–12. doi: 10.1111/j.1600-0609.1994.tb00190.x. - DOI - PubMed
    1. Terpos E, Christoulas D, Kastritis E, Katodritou E, Pouli A, Michalis E, et al. The Chronic Kidney Disease Epidemiology Collaboration Cystatin-C (CKD-EPI-CysC) Equation Has an Independent Prognostic Value for Overall Survival in Newly-Diagnosed Patients with Symptomatic Multiple Myeloma; Is It Time to Change from MDRD to CKD-EPI-CysC equations? Eur J Haematol. 2013;91:347–55. - PubMed
    1. Kleber M, Ihorst G, Deschler B, Jakob C, Liebisch P, Koch B, et al. Detection of renal impairment as one specific comorbidity factor in multiple myeloma: multicenter study in 198 consecutive patients. Eur J Haematol. 2009;83:519–27. doi: 10.1111/j.1600-0609.2009.01318.x. - DOI - PubMed
    1. Ho PJ, Moore EM, McQuilten ZK, Wellard C, Bergin K, Augustson B, et al. Renal Impairment at Diagnosis in Myeloma: Patient Characteristics, Treatment, and Impact on Outcomes. Results From the Australia and New Zealand Myeloma and Related Diseases Registry. Clin Lymphoma Myeloma Leuk. 2019;19:e415–e24. doi: 10.1016/j.clml.2019.05.010. - DOI - PubMed
    1. Courant M, Orazio S, Monnereau A, Preterre J, Combe C, Rigothier C. Incidence, prognostic impact and clinical outcomes of renal impairment in patients with multiple myeloma: a population-based registry. Nephrol Dial Transpl. 2021;36:482–90. doi: 10.1093/ndt/gfz211. - DOI - PubMed

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