Management of multiple myeloma-related renal impairment: recommendations from the International Myeloma Working Group

Dimopoulos, MA; Merlini, G; Bridoux, F; Leung, N; Mikhael, J; Harrison, SJ; Kastritis, E; Garderet, L; Gozzetti, A; van de Donk, NWCJ; Weisel, KC; Badros, AZ; Beksac, M; Hillengass, J; Mohty, M; Ho, PJ; Ntanasis-Stathopoulos, I; Mateos, MV; Richardson, P; Blade, J; Moreau, P; San-Miguel, J; Munshi, N; Rajkumar, SV; Durie, BGM; Ludwig, H; Terpos, E; International Myeloma Working Group

Author(s): Dimopoulos, MA; Merlini, G; Bridoux, F; Leung, N; Mikhael, J; Harrison, SJ; Kastritis, E; Garderet, L; Gozzetti, A; van de Donk, NWCJ; Weisel, KC; Badros, AZ; Beksac, M; Hillengass, J; Mohty, M; Ho, PJ; Ntanasis-Stathopoulos, I; Mateos, MV; Richardson, P; Blade, J; Moreau, P; San-Miguel, J; Munshi, N; Rajkumar, SV; Durie, BGM; Ludwig, H; Terpos, E; International Myeloma Working Group;
Details: Publication Year 2023-07,Volume 24,Issue #7,Page e293-e311
Journal Title: Lancet Oncology
Publication Type: Review
Abstract: Here, the International Myeloma Working Group (IMWG) updates its clinical practice recommendations for the management of multiple myeloma-related renal impairment on the basis of data published until Dec 31, 2022. All patients with multiple myeloma and renal impairment should have serum creatinine, estimated glomerular filtration rate, and free light chains (FLCs) measurements together with 24-h urine total protein, electrophoresis, and immunofixation. If non-selective proteinuria (mainly albuminuria) or involved serum FLCs value less than 500 mg/L is detected, then a renal biopsy is needed. The IMWG criteria for the definition of renal response should be used. Supportive care and high-dose dexamethasone are required for all patients with myeloma-induced renal impairment. Mechanical approaches do not increase overall survival. Bortezomib-based regimens are the cornerstone of the management of patients with multiple myeloma and renal impairment at diagnosis. New quadruplet and triplet combinations, including proteasome inhibitors, immunomodulatory drugs, and anti-CD38 monoclonal antibodies, improve renal and survival outcomes in both newly diagnosed patients and those with relapsed or refractory disease. Conjugated antibodies, chimeric antigen receptor T-cells, and T-cell engagers are well tolerated and effective in patients with moderate renal impairment.
Publisher: Elsevier
Keywords: Humans; *Multiple Myeloma/complications/diagnosis/drug therapy; Dexamethasone; *Antineoplastic Agents/adverse effects; *Renal Insufficiency/etiology/therapy; Antineoplastic Combined Chemotherapy Protocols/adverse effects; Bortezomib/therapeutic use
Department(s): Clinical Haematology
PubMed ID: 37414019
Publisher's Version: https://doi.org/10.1016/S1470-2045(23)00223-1
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2023-10-19 04:37:30

Last Modified: 2024-07-09 05:21:57