Nephrologists are interested in the treatment of AKI in the course of MM because the survival of patients is affected by the recovery of normal renal function, not only for the specific complications of AKI but also for the reduced opportunities for access to more effective drug treatments. The evolution of renal disorders associated with monoclonal light chains in MM remains poorly defined. .
A Caucasian 38-year-old patient underwent autologous hematopoietic stem cell transplantation(ASCT); he was suffering from ARF due to micromolecular lambda MM stage III B. Renal biopsy showed a cast nephropathy. The search for amyloid was negative. He was for 12 months on haemodialysis treatment twice a week.
He received 4 cycles Bortezomib, Adriamycin-Dexamethasone as induction therapy before ASCT. The patient did not report any bortezomib-related adverse effect. Stem-cell mobilization was undertaken with cyclophosphamide 4 gr ev in two divided doses (the dose was reduced in consideration of renal function) plus granulocyte colony-stimulating factor. Conditioning for ASCT consisted of melphalan 200 mg/m2 in two divided doses. The ASCT was effective with documented engraftment in the fourteenth day. Following the hematopoietic recovery, the patient did not received any chemotherapic maintenance treatment. Up to now (after 36 months from AKI) the patient continues haemodialysis once a week.
This report showed the tolerability of treatment with bortezomib plus dexamethasone in subjects with ESRD. The rapid reduction in circulating levels of free light chains (FLC) is critical to the recovery of renal function. Aggressive removal of circulating FLC by blood purification accompanied by chemotherapy is a promising approach for the treatment of AKI due to myeloma cast nephropathy. Recently a treatment with high cut-off dialyzers has recently become available . This treatment resulted in a high percentage of recovery of renal function in myeloma cast nephropathy.
