Table 2.

Therapeutic options for monoclonal gammopathies of renal significance

Agent (Dosage Form)Clone SensitivityDose Adjustment for eGFR?Described Kidney-Associated ToxicitiesCommon Adverse Events
B CellPlasma Cell
Proteasome inhibitors
 Bortezomib (IV, SC)XXNoNoneThrombocytopenia
Peripheral neuropathy
Varicella zoster reactivation
 Carfilzomib (IV)XXYesAKI, thrombotic microangiopathyThrombocytopenia
Dyspnea
Hypersensitivity reaction
Varicella zoster reactivation
Monoclonal antibodies
 Rituximab (anti-CD20) (IV)XNoNoneInfusion reactions
Hepatitis B reactivation
 Daratumumab (anti-CD38) (IV)XNoNoneInfusion reactions
Cytotoxic agents
 Cyclophosphamide (IV, PO)XXNoNoneNausea
Cytopenias
 Melphalan (IV, PO)XXYesNoneNausea
Cytopenias
 Bendamustine (IV)XXYesNoneCytopenias
Immunomodulatory agents
 Thalidomide (IV, PO)XXNoHyperkalemia observed in renal insufficiencyConstipation
Fatigue, somnolence
Peripheral neuropathy
Venous thrombosis
Rash
Teratogenicity
 Lenalidomide (IV)XXYesIncreased myelosuppression in renal insufficiency, AKI observed in AL amyloidosisCytopenias
Venous thrombosis
Diarrhea
Constipation
Rash
Teratogenicity
 Pomalidomide (IV)XUnknownNoCytopenias
Venous thrombosis
Diarrhea; Constipation
Teratogenicity
Other agents
 Fludarabine (IV)XYesNoneCytopenias
Opportunistic infections
Hemolytic anemia
Secondary myeloid neoplasms
 Pentostatin (IV)XYesIncreased creatinineCytopenias
Opportunistic infections
Hemolytic anemia
 Ibrutinib (PO)XUnknownIncreased creatinineBleeding
Tachyarrhythmias
  • IV, intravenous; SC, subcutaneous; PO, oral; AL, amyloid light chain amyloidosis.