Managing multiple myeloma patients with renal failure

Publication date: October 2013 Source:Hong Kong Journal of Nephrology, Volume 15, Issue 2 Author(s): Patrick Chu Renal 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...
Source: Hong Kong Journal of Nephrology - Category: Urology & Nephrology Source Type: research