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International Myeloma Working Group Recommendations for Myeloma-Related Renal Impairment

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International Myeloma Working Group recommendations for the diagnosis and management of myeloma-related renal impairment were recently reported by Dimopoulos et al in the Journal of Clinical Oncology. Recommendations were based on review of published data through December 2015. Key recommendations are reproduced/summarized here, with grade of recommendation shown in parentheses.

Recommendations

  • At diagnosis and disease assessment, all patients with myeloma should have serum creatinine, estimated glomerular filtration rate, and electrolytes measurements, as well as free light chain, if available, and urine electrophoresis of a sample from 24-hour urine collection (grade A).
  • The Chronic Kidney Disease Epidemiology Collaboration, preferably, or the Modification of Diet in Renal Disease formula should be used for the evaluation of estimated glomerular filtration rate in patients with stabilized serum creatinine (grade A).
  • International Myeloma Working Group criteria for renal response should be used (grade B).
  • For management of renal impairment, high fluid intake is indicated along with antimyeloma therapy (grade B).
  • Use of high-cutoff hemodialysis membranes in combination with antimyeloma therapy can be considered (grade B).
  • Bortezomib-based regimens remain the cornerstone of the management of renal impairment (grade A).
  • High-dose dexamethasone should be administered for at least the first month of therapy (grade B).
  • Thalidomide is effective in patients with renal impairment, and no dose modifications are needed (grade B).
  • Lenalidomide is effective and safe, mainly in patients with mild to moderate renal impairment (grade B); for patients with severe impairment on dialysis, lenalidomide should be given with close monitoring for hematologic toxicity (grade B), with dose reduction as needed.
  • High-dose therapy with autologous stem cell transplantation (with melphalan at 100 to 140 mg/m2) is feasible (grade C).
  • Carfilzomib can be safely administered to patients with creatinine clearance > 15 mL/min, whereas ixazomib in combination with lenalidomide and dexamethasone can be safely administered to patients with creatinine clearance > 30 mL/min (grade A).

Meletios A. Dimopoulos, MD, of the National and Kapodistrian University of Athens School of Medicine, is the corresponding author of the Journal of Clinical Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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