Extracorporeal light-chain elimination in myeloma with simple medium cutoff membrane hemodialysis: a retrospective cohort study.

Schaaf, Christian W; Braunisch, Matthias C; Holzmann-Littig, Christopher; Pfister, Frederick; Hannemann, Liya; Hausinger, Renate I; Verbeek, Mareike; Schmaderer, Christoph; Renders, Lutz; Heemann, Uwe; Küchle, Claudius

doi:10.3389/fonc.2023.1193504

Professur für Nephrologie (Prof. Heemann)

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Title:: Extracorporeal light-chain elimination in myeloma with simple medium cutoff membrane hemodialysis: a retrospective cohort study.
Document type:: Journal Article
Author(s):: Schaaf, Christian W; Braunisch, Matthias C; Holzmann-Littig, Christopher; Pfister, Frederick; Hannemann, Liya; Hausinger, Renate I; Verbeek, Mareike; Schmaderer, Christoph; Renders, Lutz; Heemann, Uwe; Küchle, Claudius
Abstract:: BACKGROUND: We determined the efficacy of free light chain (FLC) removal by regular dialysis equipment (high-flux filtration) with medium cutoff (MCO) membrane hemodialysis (HD) as an adjuvant treatment to standard chemotherapy for patients with acute kidney injury complicating multiple myeloma (MM) and its impact on further dialysis dependency. METHODS: Sixty patients with acute dialysis-dependent renal failure secondary to MM were treated with MCO-HD (55 patients) or HCO (high cutoff)-HD (5 patients) as a control. FLC serum concentration, total protein, immunoglobulins, and LDH were measured throughout the dialysis therapy. The kidney function of the patients was followed up for 1 year. RESULTS: The median age was 69 years; 25 female and 35 male patients were enrolled. HD significantly reduced FLC kappa levels in the MCO/HCO group by 58%/84% (MCO/HCO group; p < 0.05) and FLC lambda by 39%/33% (MCO/HCO group; p < 0.05). Single HD data (MCO) showed a relative reduction of 70% in kappa and 37% in lambda FLC concentration, as expected by the different sizes of the light chains. Renal function improved significantly and continuously from starting creatinine 5.7/3.8 mg/dl (MCO/HCO group) before HD to 1.4/2.0 mg/dl (MCO/HCO group; p < 0.001) after 1 year. No significant alteration of total protein, immunoglobulins, and LDH concentrations by HD (HCO and MCO group) was observed. After 1 year, 37 of 60 patients were alive and 34 of them were off dialysis. CONCLUSION: FLC elimination with MCO-HD is effective, technically easy, and less cost-intensive as compared with HCO-HD. Kidney function recovery in MM patients is achievable.
Journal title abbreviation:: Front Oncol
Year:: 2023
Journal volume:: 13
Fulltext / DOI:: doi:10.3389/fonc.2023.1193504
Pubmed ID:: http://view.ncbi.nlm.nih.gov/pubmed/37746285
Print-ISSN:: 2234-943X
TUM Institution:: Klinik und Poliklinik für Innere Medizin III, Hämatologie und Onkologie (Prof. Bassermann); Professur für Nephrologie (Prof. Heemann)
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mediaTUM Gesamtbestand Einrichtungen Schools TUM School of Medicine and Health Departments Clinical Medicine Klinik und Poliklinik für Innere Medizin III, Hämatologie und Onkologie (Prof. Bassermann)2023

mediaTUM Gesamtbestand Einrichtungen Schools TUM School of Medicine and Health Departments Clinical Medicine Klinik und Poliklinik für Innere Medizin II, Gastroenterologie (Prof. Schmid)Abteilung für Nephrologie (Prof. Heemann)Professur für Nephrologie (Prof. Heemann)2023