EARLY APPLICATION OF HIGH CUT-OFF HAEMODYALISIS FOR DE-NOVO MYELOMA NEPHROPATHY IS ASSOCIATED WITH LONG-TERM DIALYSIS-INDEPENDENCY AND RENAL RECOVERY

Main Article Content

Alhossain A. Khalafallah *
Sie Wuong Loi
Sarah Love
Muhajir B. Mohamed
Rose Mace
Ramy Khalil
Miriam Girgs
Rajesh Raj
Mathew Mathew
(*) Corresponding Author:
Alhossain A. Khalafallah | alhossain@yahoo.com

Abstract

Background

Multiple myeloma (MM) is a haematological malignancy associated with kidney injury resulting from cast nephropathy, which can be caused by monoclonal free light chains (FLC). It has been demonstrated that reduction of FLC can lead to a higher proportion of patients recovering renal function with a better outcome, especially if extended high cut-off haemodialysis (HCO-HD) combined with chemotherapy is used.

Patients and Methods

In this study, four cases of MM nephropathy were treated with HCO-HD and chemotherapy at a single institution during the period from August 2009 to August 2011. All of the patients presented with acute renal failure and high serum FLC. All patients underwent a bone marrow biopsy to confirm the diagnosis of MM, according to the WHO criteria. Three patients had de-novo MM and one patient had relapsed light chain myeloma disease. All patients underwent HCO-HD concomitantly with specific myeloma therapy once the diagnosis or relapse of MM was established.

Results

After a median follow up of 26 months, (range, 13-36) our data showed that all patients had a significant decrease in serum FLC through HCO-HD, proving the effectiveness of HCO-HD in managing MM. De-novo MM patients restored their renal function and achieved low-level FLC early on the treatment and become dialysis-independent. One patient with relapsed myeloma remained dialysis dependant.

Conclusion

Our study suggests that if myeloma nephropathy associated with light-chain disease, HCO-HD should be initiated as early as possible. At the same time a specific MM treatment should be initiated to gain control of the disease and salvage the kidneys in order to achieve dialysis-independency. Further trials to confirm our results are warranted.

Key Words: Multiple myeloma, renal failure, High cut-off haemodialysis, chemotherapy, outcome.


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Author Biographies

Alhossain A. Khalafallah, Launceston General Hospital School of Human Life Sciences, University of Tasmania

Department of Haematology and MedicineThe Launceston General HospitalCharles StreetLaunceston, TAS 7250Australia

Sie Wuong Loi, The Launceston General Hospital Launceston, Australia

Haemtology DepartmentThe Launceston General HospitalCharles StreetLaunceston, TAS 7250Australia

Sarah Love, Faculty of Health and Life Sciences, Coventry University, Coventry, West Midlands, UK.

Faculty of Health and Life Sciences, Coventry University, Coventry, West Midlands, UK.

Muhajir B. Mohamed, The Launceston General Hospital Launceston, Australia

Haemtology DepartmentThe Launceston General HospitalCharles StreetLaunceston, TAS 7250Australia

Rose Mace, The Launceston General Hospital Charles Street Launceston, TAS 7250 Australia

Department of NephrologyThe Launceston General HospitalCharles StreetLaunceston, TAS 7250Australia

Ramy Khalil, The Launceston General Hospital Charles Street Launceston, TAS 7250 Australia

Department of MedicineThe Launceston General HospitalCharles StreetLaunceston, TAS 7250Australia

Miriam Girgs, The Launceston General Hospital Charles Street Launceston, TAS 7250 Australia

Department of MedicineThe Launceston General HospitalCharles StreetLaunceston, TAS 7250Australia

Rajesh Raj, The Launceston General Hospital Charles Street Launceston, TAS 7250 Australia

Department of NephrologyThe Launceston General HospitalCharles StreetLaunceston, TAS 7250Australia

Mathew Mathew, The Launceston General Hospital Charles Street Launceston, TAS 7250 Australia

Department of NephrologyThe Launceston General HospitalCharles StreetLaunceston, TAS 7250Australia