Early Reduction of Serum-Free Light Chains Associates with Renal Recovery in Myeloma Kidney
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Transcript of Early Reduction of Serum-Free Light Chains Associates with Renal Recovery in Myeloma Kidney
Early Reduction of Serum-Free Light Chains Associates with Renal Recovery in Myeloma Kidney
Sophina HissaundFY2
Aims
• Myeloma• The Study• Treatment• Results• Survival• Conclusion• Discussion
Myeloma
• Malignant clonal proliferation of B-lymphocyte derived plasma cells
• A single clone of plasma cells produce identical immunoglobulins seen as a monoclonal band, or paraprotein, on serum or urine electrophoresis
Myeloma Kidney
• Myeloma kidney can cause severe irreversible renal failure in patients with multiple myeloma
• The tubulointerstitial injury is a consequence of high concentrations of circulating monoclonal FLCs produced by a clonal expansion of plasma cells
The Study• To determine the relationship between the achieved early FLC
reduction and renal recovery
• University Hospital Birmingham and Mayo Clinic, Rochester, Minnesota
• 39 patients
• 23 male, 16 female
• Median age 62 years
The Study
• Severe renal failure at presentation
• Biopsy proven myeloma kidney
• 79% first presentation of myeloma
• 15% MGUS before diagnosis
• 24 patients required dialysis support
Treatment
• Birmingham – combination of extended haemodialysis with
thalidomide-based chemotherapy for patients with new presentation of myeloma
– Bortezomib for relapsing disease
Treatment
• Minnesota– Plasma exchange in combination with
chemotherapy regimen consisting of high dose steroids used alone or with Bortezomib, thalidomide, melphalan, vincristine, doxorubicin or alemtuzumab
Results
Day 12 – each increment of 10% FLC reduction was associated with a 60% increase in likelihood of renal recovery
Results
Day 21 –an additional 10% FLC reduction was associated with 60% increased likelihood of recovery
The relationship of reduction in serum FLCs and renal recovery is linear in patients with myeloma kidney
Results
Long Term Survival Outcomes
• Median survival of patients who recovered renal function was 42.7 months
• Risk of death 3x lower for patients with a new myeloma and those with renal recovery
• Patients with λ FLCs had a significant higher likelihood of death
Long Term Survival Outcomes
No significant association between % reduction of serum FLC concentration and survival
Conclusion
• No absolute threshold by which FLCs must be reduced to facilitate renal recovery
• To enable a renal recovery rate of 80%, a 60% reduction in FLC levels by day 21 is required
• Targeting treatment to reverse renal failure in myeloma kidney by early reduction of FLCs is critical
Discussion
• Combination
• Plasma exchange
• Biopsy results
• Pre –existing renal disease
• Small study
Thank you