Dimopoulos MA et al. - In a review of renal failure as a frequent complication in pts with multiple myeloma (MM), it was shown that clinical studies that have included newly diagnosed and refractory pts indicate that bortezomib-based regimens may result in rapid reversal of renal failure in up to 50% of pts and that full doses of bortezomib can be administered without additional toxicity Methods
In the majority of cases, renal impairment is caused by accumulation and precipitation of light chains, which form casts in the distal tubules, resulting in renal obstruction
Myeloma light chains are also directly toxic on proximal renal tubules, further adding to renal dysfunction
Results
Adequate hydration, correction of hypercalcemia and hyperuricemia and antimyeloma therapy should be initiated promptly
Recovery of renal function has been reported in a significant proportion of pts treated with conventional chemotherapy, especially when high-dose dexamethasone is also used
Severe renal impairment and large amount of proteinuria are associated with a lower probability of renal recovery
Novel agents, such as thalidomide, bortezomib and lenalidomide, have significant activity in pretreated and untreated MM pts
Although there is limited experience with thalidomide and lenalidomide in pts with renal failure, data suggest that bortezomib may be beneficial in this population
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