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Treatment of Acute Renal Failure Secondary to Multiple Myeloma with Chemotherapy and Extended High Cut-Off Hemodialysis

Colin A. Hutchison^*,, Arthur R. Bradwell, Mark Cook, Kolitha Basnayake^*,, Supratik Basu^||, Stephen Harding^¶, John Hattersley^**, Neil D. Evans^**, Mike J. Chappel^**, Paul Sampson^*, Lukas Foggensteiner^*, Dwomoa Adu^*, and Paul Cockwell^*,

^* Department of Nephrology and Department of Haematology, Queen Elizabeth Hospital, Birmingham; Division of Medical Sciences and Division of Immunity and Infection, Medical School, University of Birmingham; ^|| Department of Haematology, New Cross Hospital, Wolverhampton; ^¶ The Binding Site Ltd., Birmingham; ^** School of Engineering, University of Warwick, Coventry, United Kingdom

Correspondence: Dr. Colin A. Hutchison, Department of Nephrology, University Hospital Birmingham, QEMC, Birmingham, B179SB. Phone: +44-7723917870; Fax: +441214306482; E-mail: c.a.hutchison{at}bham.ac.uk

Background and objectives: Extended hemodialysis using a high cut-off dialyzer (HCO-HD) removes large quantities of free light chains in patients with multiple myeloma. However, the clinical utility of this method is uncertain. This study assessed the combination of chemotherapy and HCO-HD on serum free light chain concentrations and renal recovery in patients with myeloma kidney (cast nephropathy) and dialysis-dependent acute renal failure.

Design, setting, participants, & measurements: An open-label study of the relationship between free light chain levels and clinical outcomes in 19 patients treated with standard chemotherapy regimens and HCO-HD.

Results: There were sustained early reductions in serum free light chain concentrations (median 85% [range 50 to 97]) in 13 patients. These 13 patients became dialysis independent at a median of 27 d (range 13 to 120). Six patients had chemotherapy interrupted because of early infections and did not achieve sustained early free light chain reductions; one of these patients recovered renal function (at 105 d) the remaining 5 patients did not recover renal function. Patients who recovered renal function had a significantly improved survival (P < 0.012).

Conclusion: In dialysis-dependent acute renal failure secondary to myeloma kidney, patients who received uninterrupted chemotherapy and extended HCO-HD had sustained reductions in serum free light chain concentrations and recovered independent renal function.