Warning: file_get_contents(https://eutils.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&id=28508984
&cmd=llinks): Failed to open stream: HTTP request failed! HTTP/1.1 429 Too Many Requests
in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 215
Successful treatment of myeloma cast nephropathy using bortezomib-based
chemotherapy plus selective plasma exchange
#MMPMID28508984
Kawabe M
; Yamamoto I
; Katsuma A
; Hayashi N
; Komatsuzaki Y
; Nakada Y
; Shimizu A
; Tanno Y
; Ohkido I
; Tsuboi N
; Suzuki K
; Shimada T
; Ogasawara Y
; Sugiyama K
; Aiba K
; Yokoo T
CEN Case Rep
2016[Nov]; 5
(2
): 232-237
PMID28508984
show ga
Myeloma cast nephropathy is a major complication of multiple myeloma. Recent
evidence has demonstrated that the earlier induction of bortezomib-based
chemotherapy with plasma exchange (PE) provides better results for kidney
function and patient survival. Due to its non-selectivity, PE with albumin
replacement carries the risk of fibrinogen loss, leading to bleeding. We herein
report a case of successful treatment of myeloma cast nephropathy using
bortezomib-based chemotherapy and selective PE. A 61-year-old woman who had a
20-year history of type II diabetes mellitus was admitted to our hospital for the
evaluation of hypercalcemia, severe kidney dysfunction, and anemia. Subsequent
bone marrow evaluation and renal biopsy revealed that she had multiple myeloma
(IgG-?) and myeloma cast nephropathy. Ten days after admission, bortezomib-based
chemotherapy with selective PE achieved rapid and thorough free light-chain (FLC)
reduction; within a month, her kidney function had been recovered (creatinine
level, 1.2 mg/dl). Her serum fibrinogen level was not reduced, and no bleeding
complication occurred. Five months later, autologous hematopoietic stem-cell
transplantation was performed successfully, and the patient's kidney function was
stable (creatinine level, 1.1 mg/dl) thereafter. This case report demonstrates
the importance of early induction therapy with bortezomib-based chemotherapy and
PE in a patient with myeloma cast nephropathy, which is especially applicable in
patients aged <65 years. In addition, it shows that selective PE is a safe and
effective method of FLC removal.
free
free
free
