Management of multiple myeloma-related renal impairment: recommendations from the International Myeloma Working Group

This IMWG manuscript by Meletios A. Dimopoulos et al. provides an overview of the management of renal impairment in multiple myeloma patients. Renal impairment is a common complication in myeloma, occurring in around 20-25% of newly diagnosed patients and up to 50% of patients with advanced disease. The authors discuss the pathogenesis, diagnosis, and treatment strategies for myeloma-related renal impairment.

The main causes of renal impairment in myeloma include cast nephropathy from free light chains, hypercalcemia, dehydration, hyperuricemia, and other patient-related and disease-related factors. Early diagnosis through serum free light chain assessment and renal biopsy is crucial. Reversal of renal impairment can improve overall survival and enable more effective anti-myeloma therapy.

The authors outline the treatment approach, which involves managing precipitating factors, supportive care measures like fluid replacement and alkalinization, and prompt initiation of anti-myeloma therapy to reduce light chain production. Bortezomib-based regimens and light chain removal techniques like high cut-off hemodialysis may help improve renal outcomes.

Renal adjustment of anti-myeloma drug dosing is necessary in patients with renal impairment. The paper provides specific dosing recommendations for various antimyeloma agents based on creatinine clearance levels. Autologous stem cell transplantation can be considered in eligible patients after achieving renal response.

In summary, this comprehensive review highlights the importance of early recognition and management of myeloma-related renal impairment to improve patient outcomes and enable optimal anti-myeloma treatment delivery.

Key Points:

1. Renal impairment is a common complication in multiple myeloma, occurring in 20-25% of newly diagnosed patients and up to 50% of those with advanced disease.
2. The main causes of renal impairment include cast nephropathy from free light chains, hypercalcemia, dehydration, and hyperuricemia.
3. Early diagnosis through serum free light chain assessment and renal biopsy is crucial for prompt management.
4. Reversal of renal impairment can improve overall survival and enable more effective anti-myeloma therapy.
5. Treatment involves managing precipitating factors, supportive care measures like fluid replacement and alkalinization, and prompt initiation of anti-myeloma therapy to reduce light chain production.
6. Bortezomib-based regimens and light chain removal techniques like high cut-off hemodialysis may help improve renal outcomes.
7. Renal adjustment of anti-myeloma drug dosing is necessary in patients with renal impairment, and the paper provides specific dosing recommendations.
8. Autologous stem cell transplantation can be considered in eligible patients after achieving renal response.
9. Early recognition and management of myeloma-related renal impairment are crucial for improving patient outcomes and enabling optimal anti-myeloma treatment delivery.