Rapid reduction of extremely high kappa free light chains in a patient with myeloma cast nephropathy

2018 ◽  
Vol 33 (3) ◽  
pp. 439-443 ◽  
Author(s):  
Christine L. H. Snozek ◽  
Theresa N. Kinard ◽  
Jill Adamski
Keyword(s):  
Light Chains ◽  
Free Light Chains ◽  
Rapid Reduction ◽  
Cast Nephropathy ◽  
Myeloma Cast Nephropathy

scholarly journals Effective Removal of κ-Free Light Chains with Hemodialysis Using Fresenius Ultraflux® EMiC®2 Dialyser in a Patient with Myeloma Cast Nephropathy, with Associated Cost Savings

2016 ◽  
Vol 42 (2) ◽  
pp. 158-159 ◽  
Author(s):  
Mathini Jayaballa ◽  
Bhadran Bose ◽  
Muralikrishna Gangadharan Komala ◽  
Eddy Ronald Fischer ◽  
John Taper ◽  
...  
Keyword(s):  
Cost Savings ◽  
Light Chains ◽  
Free Light Chains ◽  
Cast Nephropathy ◽  
Effective Removal ◽  
Myeloma Cast Nephropathy

MO670EXPANDED HEMODIALYSIS REDUCES THE CONCENTRATION OF FREE LIGHT CHAINS IN PATIENTS WITH ACUTE KIDNEY INJURY IN MYELOMA CAST NEPHROPATHY

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Konstantin Vishnevskii ◽  
Olga Domashenko
Keyword(s):  
Multiple Myeloma ◽  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Average Concentration ◽  
High Flow ◽  
Low Flow ◽  
Light Chains ◽  
Free Light Chains ◽  
Cast Nephropathy ◽  
Myeloma Cast Nephropathy

Abstract Background and Aims The myeloma cast nephropathy is largely associated with the production of intact immunoglobulin and free light chains (FLC) by a plasma cells monoclone. The use of high-flux hemodiafiltration (HDF) contributes to a decrease in the concentration of FLC. However, it is not always possible to achieve the required substitute volume with acute kidney injury (AKI) emergency treatment. An alternative to HDF could be the usage of membranes with a medium cut-off (expanded hemodialysis (HD), Expanded HD). The aim of this study was to compare the degree of reduction in FLC concentration using conventional HD, HDF and Expanded HD. Method The study includes patients with newly diagnosed multiple myeloma who presented indications for HD therapy start. Procedures were performed on a daily basis from the moment when indications for HD therapy were identified. The duration of the first three procedures was 2 hours. Consistently for each patient the first procedure was carried out using a standard low-flow filter, the second - using a high-flow dialyzer and HDF (substitute volume 9 liters for 2 hours), the third - using a Theranova 400 filter (Baxter, Germany). The concentrations of FLC (kappa and lambda) and albumin were determined every 30 minutes of each treatment. Chemotherapy was prescribed according to the local clinical recommendations in combination with the ongoing renal replacement therapy. Results The study included 7 patients with cast nephropathy, mean age 68±8 years. Average concentration before treatment: kappa FLC 876±727 μg/ml (norm 3.25-15.81 μg/ml), lambda FLK 84±112 μg/ml (norm 3.23-28.05 μg/ml), albumin 34±1 g/l (norm 40-50 g/l). After 2 hours of treatment, there was a decrease in kappa FLC concentration with HDF (-34±33%, p=0.01) and with Expanded HD (-31±12%, p<0.001), but not with conventional HD (-1±7, p=0.79, Fig 1). The lambda FLC concentration also decreased with HDF (-41±29%, p=0.01) and with Expanded HD (-28±22%, p=0.01), but not with conventional HD (-3±12, p=0.65, Fig 2). Albumin concentrations did not change significantly with any of the treatments. Conclusion Expanded HD, as well as high-flow HDF, helps to reduce the FLC concentration in patients with cast nephropathy without loss of albumin, which may have a positive effect on the multiple myeloma prognosis. Further studies are needed regarding possibilities of using Expanded HD in the complex therapy for patients with AKI in myeloma cast nephropathy.

scholarly journals Extracorporeal light chains removal – What role does this play in 2020?

2021 ◽  
Vol 34 (4) ◽  
Author(s):  
Inês Coelho ◽  
◽  
Hugo Ferreira ◽  
Teresa Chuva ◽  
Ana Paiva ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Kidney Injury ◽  
Rapid Decrease ◽  
Light Chains ◽  
Free Light Chains ◽  
Monoclonal Immunoglobulin ◽  
Serum Free ◽  
Cast Nephropathy ◽  
Cell Clones ◽  
Serum Free Light Chains

Multiple Myeloma (MM) is characterized by a neoplastic proliferation of plasma cell clones producing monoclonal immunoglobulin. Manifestations of the disease are heterogenous and include dialysis­‑requiring acute kidney injury (AKI) caused mainly by cast nephropathy (CN). It is known that early and rapid decrease in serum free light chains (sFLC) levels is particularly important for renal recovery, which has led to a renewed interest in extracorporeal methods of removal of sFLC. In this review we will discuss the management of light chain CN focusing on extracorporeal light chains removal modalities and their indication.

A Review of Multiple Myeloma Patients on Dialysis Treated with High Cutoff Hemodialysis

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 5002-5002
Author(s):  
Tiina Podymow ◽  
Ahsan Alam ◽  
Murray Vasilevsky ◽  
Roch Beauchemin ◽  
Chaim Shustik ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Kidney Function ◽  
Kidney Failure ◽  
Conflicts Of Interest ◽  
Controlled Trial ◽  
Light Chains ◽  
Free Light Chains ◽  
Serum Free ◽  
Cast Nephropathy ◽  
Serum Free Light Chains

Abstract Abstract 5002 Background: Kidney failure is a major cause of morbidity in patients with Multiple Myeloma (MM). While up to half of MM patients can be shown to have renal impairment, 10% will become dialysis dependent. The main mechanism of kidney failure is cast nephropathy, which is linked to high amounts of circulating free light chains. A proposed strategy to prevent this outcome is the use of extended high cutoff (HCO) dialysis. An ongoing randomized controlled trial is testing the Gambro HCO1100 filter. Here we report the use of another dialyzer (Bellco Phylther), which has a smaller pore size than the Gambro filter, but which may prove to be as effective and is less costly. Methods: We present three patients with symptomatic MM, elevated κ or λ serum free light chains (>500mg/L), biopsy confirmed cast nephropathy, and kidney failure (estimated GFR <15ml/min/1.73 m2) requiring dialysis. In all patients, dialysis consisted of 10 hemodiafiltration dialysis sessions in the first two weeks and three times a week thereafter using a high flux Bellco Phylther HF22SD dialyzer (Bellco, Modena, Italy). All patients received concurrent chemotherapy: bortezomib 1.3mg/m2 IV and dexamethasone 40mg po on days 1, 4, 8 and 11 of a 21 day cycle and liposomal doxorubicin at 30mg/m2 on day 4 of every cycle. Serum free light chains were determined pre- and immediately post-dialysis using a nephelometric immunoassay (FREELITE, The Binding Site, Birmingham UK). Results: We observed significant (>50%) and rapid reductions in sFLCs. These reductions were sustained at 3 months in all cases, likely because of effective anti-myeloma treatment. Two of the three patients had recovery of kidney function and remain dialysis-independent at least 6 months after cessation of dialysis. Interestingly, the only patient that did not recover kidney function was also found to have tubulointerstitial disease on renal biopsy in addition to cast nephropathy. Conclusions: The HCO Bellco Phylther dialyzer appears effective in the rapid reduction of sFLCs in light chain MM patients with cast nephropathy requiring dialysis and concurrent anti-myeloma drug therapy. While the numbers are small, our review suggests that patients with uncomplicated MM cast nephropathy may benefit from aggressive hemodiafiltration with this HCO membrane. This dialysis membrane and protocol are worth considering for further study in patients with MM cast nephropathy. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Cast Nephropathy: Removal of Serum Free Light Chains by High Cut-off Hemodialysis

2015 ◽  
Vol 17 (2) ◽  
pp. S119
Author(s):  
H.L. Tang ◽  
H.M. Cheng ◽  
C.K.Y. Poon ◽  
L.Y. Wong ◽  
H.K.K. Lee ◽  
...  
Keyword(s):  
Light Chains ◽  
Free Light Chains ◽  
Serum Free ◽  
Cast Nephropathy ◽  
Serum Free Light Chains

scholarly journals Improvement of cast nephropathy with plasma exchange depends on the diagnosis and on reduction of serum free light chains

2008 ◽  
Vol 73 (11) ◽  
pp. 1282-1288 ◽  
Author(s):  
N. Leung ◽  
M.A. Gertz ◽  
S.R. Zeldenrust ◽  
S.V. Rajkumar ◽  
A. Dispenzieri ◽  
...  
Keyword(s):  
Plasma Exchange ◽  
Light Chains ◽  
Free Light Chains ◽  
Serum Free ◽  
Cast Nephropathy ◽  
Serum Free Light Chains

scholarly journals Effect of high cut-off dialysis for acute kidney injury secondary to cast nephropathy in patients with multiple myeloma: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Blanca Tarragón ◽  
Nan Ye ◽  
Martin Gallagher ◽  
Shaundeep Sen ◽  
Jose Maria Portolés ◽  
...  
Keyword(s):  
Systematic Review ◽  
Multiple Myeloma ◽  
Clinical Outcomes ◽  
Meta Analysis ◽  
Kidney Injury ◽  
Light Chains ◽  
Cast Nephropathy ◽  
Myeloma Cast Nephropathy ◽  
All Cause Mortality

ABSTRACT Background Acute kidney injury (AKI) caused by cast nephropathy is associated with increased morbidity and mortality among patients with multiple myeloma (MM). High cut-off haemodialysis (HCO-HD) has proven to be effective in the removal of serum light chains but the effect on clinical outcomes, especially renal recovery, remains uncertain. Methods A systematic review and meta-analysis were performed examining all randomized controlled trials (RCTs) and observational studies (OBSs) assessing the effect of HCO-HD on clinical outcomes of patients with MM complicated by cast nephropathy–induced severe AKI. The primary outcome was all-cause mortality at the end of the study. The secondary outcomes included all-cause mortality at 12 months, HD independence and serum kappa and lambda light chain reduction. Pooled analysis was performed using random effects models. Results We identified five studies, comprising two RCTs and three retrospective cohort studies, including 276 patients with a mean follow-up of 18.7 months. The majority of the studies were of suboptimal quality and underpowered. Compared with patients treated with conventional HD, HCO-HD was not associated with a survival benefit at 12 months {five studies, 276 patients, relative risk [RR] 1.02 [95% confidence interval (CI) 0.76–1.35], I2 = 33.9%} or at the end of the studies at an average of 34 months [five studies, 276 patients, RR 1.32 (95% CI 0.71–2.45), I2 = 62.0%]. There was no difference in HD independence at 90 days [two trials, 78 patients, RR 2.23 (95% CI 1.09–4.55)], 6 months [two studies, 188 patients, RR 1.19 (95% CI 0.68–2.06)] or 12 months [two studies, 188 patients, RR 1.14 (95% CI 0.58–2.26)]. Patients receiving HCO dialysis, however, had a greater reduction in serum kappa [two studies, 188 patients, weighted mean difference (WMD) 46.7 (95% CI 38.6–54.7), I2 =  52.0%] and lambda [two studies, 188 patients, WMD 50.3 (95% CI 21.4–79.3), I2 = 95.1%] light chain levels. Conclusion Current evidence from RCTs and OBSs suggests HCO dialysis is able to reduce serum free light chains but makes no significant improvement in all-cause mortality and renal outcomes compared with conventional HD for patients with myeloma cast nephropathy. However, there is a trend towards better renal outcomes with the use of HCO dialysis. The lack of long-term data and the small sample sizes of the included studies limit this analysis. Therefore further large-scale RCTs with longer follow-up are needed to assess the effect of HCO dialysis on clinical outcomes in patients with myeloma cast nephropathy.

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