Management of multiple myeloma-related renal impairment: recommendations from the International Myeloma Working Group.
Meletios A Dimopoulos, Giampaolo Merlini, Frank Bridoux, Nelson Leung, Joseph Mikhael, Simon J Harrison, Efstathios Kastritis, Laurent Garderet, Alessandro Gozzetti, Niels W C J van de Donk, Katja C Weisel, Ashraf Z Badros, Meral Beksac, Jens Hillengass, Mohamad Mohty, P Joy Ho, Ioannis Ntanasis-Stathopoulos, Maria-Victoria Mateos, Paul Richardson, Joan Blade, Philippe Moreau, Jesus San-Miguel, Nikhil Munshi, S Vincent Rajkumar, Brian G M Durie, Heinz Ludwig, Evangelos Terpos, International Myeloma Working Group
The Lancet. Oncology 2023 JulHere, the International Myeloma Working Group (IMWG) updates its clinical practice recommendations for the management of multiple myeloma-related renal impairment on the basis of data published until Dec 31, 2022. All patients with multiple myeloma and renal impairment should have serum creatinine, estimated glomerular filtration rate, and free light chains (FLCs) measurements together with 24-h urine total protein, electrophoresis, and immunofixation. If non-selective proteinuria (mainly albuminuria) or involved serum FLCs value less than 500 mg/L is detected, then a renal biopsy is needed. The IMWG criteria for the definition of renal response should be used. Supportive care and high-dose dexamethasone are required for all patients with myeloma-induced renal impairment. Mechanical approaches do not increase overall survival. Bortezomib-based regimens are the cornerstone of the management of patients with multiple myeloma and renal impairment at diagnosis. New quadruplet and triplet combinations, including proteasome inhibitors, immunomodulatory drugs, and anti-CD38 monoclonal antibodies, improve renal and survival outcomes in both newly diagnosed patients and those with relapsed or refractory disease. Conjugated antibodies, chimeric antigen receptor T-cells, and T-cell engagers are well tolerated and effective in patients with moderate renal impairment. Copyright © 2023 Elsevier Ltd. All rights reserved.
Citation
Meletios A Dimopoulos, Giampaolo Merlini, Frank Bridoux, Nelson Leung, Joseph Mikhael, Simon J Harrison, Efstathios Kastritis, Laurent Garderet, Alessandro Gozzetti, Niels W C J van de Donk, Katja C Weisel, Ashraf Z Badros, Meral Beksac, Jens Hillengass, Mohamad Mohty, P Joy Ho, Ioannis Ntanasis-Stathopoulos, Maria-Victoria Mateos, Paul Richardson, Joan Blade, Philippe Moreau, Jesus San-Miguel, Nikhil Munshi, S Vincent Rajkumar, Brian G M Durie, Heinz Ludwig, Evangelos Terpos, International Myeloma Working Group. Management of multiple myeloma-related renal impairment: recommendations from the International Myeloma Working Group. The Lancet. Oncology. 2023 Jul;24(7):e293-e311
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PMID: 37414019
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