Effectiveness of haemodiafiltration with ultrafiltrate regeneration in the reduction of light chains in multiple myeloma with renal failure

• Published in: Nefrologia : publicacion oficial de la Sociedad Espanola Nefrologia Vol. 33; no. 6; p. 788
• Main Authors: Pendón-Ruiz de Mier, María Victoria, Alvarez-Lara, María Antonia, Ojeda-López, Raquel, Martín-Malo, Alejandro, Carracedo, Julia, Caballero-Villarraso, Javier, Alonso, Corona, Aljama, Pedro
• Format: Journal Article
• Language: English
• Published: Spain 13.11.2013
• Subjects: Acute Kidney Injury - blood; Acute Kidney Injury - therapy; Adsorption; Aged; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Boronic Acids - administration & dosage; Bortezomib; Combined Modality Therapy; Cyclophosphamide - administration & dosage; Dexamethasone - administration & dosage; Female; Hemodiafiltration - methods; Humans; Immunoglobulin kappa-Chains - blood; Immunoglobulin lambda-Chains - blood; Ion Exchange Resins; Male; Membranes, Artificial; Middle Aged; Multiple Myeloma - blood; Multiple Myeloma - complications; Multiple Myeloma - drug therapy; Myeloma Proteins - analysis; Polymers; Pyrazines - administration & dosage; Serum Albumin - analysis; Thalidomide - administration & dosage; Treatment Outcome
• ISSN: 1989-2284

Acute kidney failure in multiple myeloma (MM) occurs in 12%-20% of patients and is a poor prognostic factor for patient survival. Recent studies have shown that dialysis with a High-Cut-Off membrane (HCO) removes free light chains (FLC) effectively although with significant albumin loss. Other adsorption-based techniques, such as haemodiafiltration with ultrafiltrate regeneration by adsorption in resin (SUPRA-HFR), have not been studied. We present three cases of MM, all haemodialysis-dependent since diagnosis. Two cases were IgG kappa and one was IgA lambda. All patients were treated with chemotherapy and SUPRA-HFR. The aim of this study was to evaluate the effectiveness of SUPRA-HFR in the reduction of FLC and its effect on albumin. We collected blood samples pre- and post-dialysis, and ultrafiltrate (UF) samples pre- and post-resin 5 minutes into the session and 5 minutes from the end. The mean reduction rate of FLC in blood per session in the three patients was 53% and 63% (kappa) and 38% (lambda). In the UF, the mean FLC reduction rate was close to 99%, both at the start and at the end of dialysis, without the removal of albumin. With the results obtained we can conclude that this technique achieves an effective reduction of FLC, which is maintained throughout the session, without resin saturation and without albumin loss. Therefore, SUPRA-HFR is effective as an adjunctive therapy for MM.