Improvement of Acute Kidney Injury with Plasma Exchange to Achieve Early Reduction of Serum Free Light Chain in Multiple Myeloma

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  • 血漿交換療法による早期のFree Light Chain除去は多発性骨髄腫による急性腎障害の改善に有用である

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Acute kidney injury (AKI) caused by cast nephropathy is the most important complication in multiple myeloma (MM) patients. Plasma exchange (PE) combined with chemotherapy is known to facilitate early free light chain (FLC) reduction and renal recovery. However, the effectiveness of PE is controversial. Herein, we present 12 patients with MM and AKI treated with chemotherapy and PE. The mean estimated glomerular filtration rate at PE initiation was 14.9±8.9 mL/min/1.73m^2. Seven patients required hemodialysis. Ten patients underwent PE within 10 days of chemotherapy initiation. Eight patients achieved a partial renal response or complete renal response. Five of 7 patients no longer required dialysis. Prompt initiation of PE after chemotherapy enables early FLC reduction leading to renal improvement. However, this study indicated PE was not effective for patients with nephritic-range proteinuria, amyloidosis, or a high FLC ratio.

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