Managing multiple myeloma patients with renal failure

SummaryRenal impairment is a common and severe complication of multiple myeloma. Initial supportive treatment, especially hydration, cessation of nephrotoxic agents, avoidance of contrast for radiological studies, early treatment of infection, is often important in salvaging renal function. Bisphosphonates in patients with renal failure should be used with caution and best avoided in the initial stages, unless hypercalcemia is present. Novel criteria based on estimated Glomerular Filtration Rate (GFR) measurements are recommended for treatment in such patients and may lead to significant reversibility of renal impairment. High-dose dexamethasone therapies are highly active in myeloma patients with renal impairment. Available data support the safety and efficacy of bortezomib-based therapies in this setting, so bortezomib with dexamethasone is the recommended treatment for myeloma patients with renal impairment of any grade. A high-dose therapy with autologous stem cell transplantation can be an option for such patients; the high-dose regimen should consist of melphalan 140 mg/m2, and the procedure should be restricted to patients younger than 60 years of age with chemosensitive disease and a good performance status.腎臟損傷是多發性骨髓瘤的一個常見且嚴重併發症，初期的支持性療法對腎功能的拯救往往是重要的，特別是補液、腎毒性藥物的停止、顯影劑的避免、感染的盡早治療等措施。對於腎衰竭患者，除非已出現高鈣血症，否則應盡可能及早避免使用雙磷酸鹽類藥物。採用以 eGFR 為基礎的新標準，可能有助於腎臟損傷的顯著逆轉。對於出現腎臟損傷的骨髓瘤患者，高劑量 dexamethasone 是高度有效的療法。目前的數據支持 bortezomib 療法在這方面的安全性與功效，因此對於出現任何等級腎臟損傷的骨髓瘤患者，bortezomib 與 dexamethasone 是建議的合併療法。自體幹細胞移植的高劑量療法是另一選項，其中宜採用 melphalan 140 mg/m2，治療對象應限制於 60 歲以下、對化療敏感且功能狀況良好的病人。