Περίληψη:
Renal impairment is a common complication of multiple myeloma (MM). The
estimated glomerular filtration rate (eGFR) using the Modification of
Diet in Renal Disease formula is the recommended method for the
assessment of renal function in patients with MM with stabilized serum
creatinine. In acute renal injury, the RIFLE (risk, injury, failure,
loss and end-stage kidney disease) and Acute Renal Injury Network
criteria seem to be appropriate to define the severity of renal
impairment. Novel criteria based on eGFR measurements are recommended
for the definition of the reversibility of renal impairment. Rapid
intervention to reverse renal dysfunction is critical for the management
of these patients, especially for those with light chain cast
nephropathy. Bortezomib with high-dose dexamethasone is considered as
the treatment of choice for such patients. There is limited experience
with thalidomide in patients with myeloma with renal impairment. Thus,
thalidomide can be carefully administered, mainly in the context of
well-designed clinical trials, to evaluate if it can improve the
rapidity and probability of response that is produced by the combination
with bortezomib and high-dose dexamethasone. Lenalidomide is effective
in this setting and can reverse renal insufficiency in a significant
subset of patients, when it is given at reduced doses, according to
renal function. The role of plasma exchange in patients with suspected
light chain cast nephropathy and renal impairment is controversial.
High-dose melphalan (140 mg/m(2)) and autologous stem-cell
transplantation should be limited to younger patients with
chemosensitive disease.
J Clin Oncol 28:4976-4984. (C) 2010 by American Society of Clinical
Oncology
Συγγραφείς:
Dimopoulos, Meletios A.
Terpos, Evangelos
Chanan-Khan, Asher and
Leung, Nelson
Ludwig, Heinz
Jagannath, Sundar
Niesvizky,
Ruben
Giralt, Sergio
Fermand, Jean-Paul
Blade, Joan and
Comenzo, Raymond L.
Sezer, Orhan
Palumbo, Antonio and
Harousseau, Jean-Luc
Richardson, Paul G.
Barlogie, Bart and
Anderson, Kenneth C.
Sonneveld, Pieter
Tosi, Patrizia
Cavo,
Michele
Rajkumar, S. Vincent
Durie, Brian G. M.
San Miguel,
Jesus
Εκδότης:
AMER SOC CLINICAL ONCOLOGY 2318 MILL ROAD, STE 800, ALEXANDRIA, VA 22314 USA
