TY - JOUR
T1 - Management of multiple myeloma-related renal impairment
T2 - recommendations from the International Myeloma Working Group
AU - International Myeloma Working Group
AU - Dimopoulos, Meletios A.
AU - Merlini, Giampaolo
AU - Bridoux, Frank
AU - Leung, Nelson
AU - Mikhael, Joseph
AU - Harrison, Simon J.
AU - Kastritis, Efstathios
AU - Garderet, Laurent
AU - Gozzetti, Alessandro
AU - van de Donk, Niels W.C.J.
AU - Weisel, Katja C.
AU - Badros, Ashraf Z.
AU - Beksac, Meral
AU - Hillengass, Jens
AU - Mohty, Mohamad
AU - Ho, P. Joy
AU - Ntanasis-Stathopoulos, Ioannis
AU - Mateos, Maria Victoria
AU - Richardson, Paul
AU - Blade, Joan
AU - Moreau, Philippe
AU - San-Miguel, Jesus
AU - Munshi, Nikhil
AU - Rajkumar, S. Vincent
AU - Durie, Brian G.M.
AU - Ludwig, Heinz
AU - Terpos, Evangelos
N1 - Publisher Copyright:
© 2023 Elsevier Ltd
PY - 2023/7
Y1 - 2023/7
N2 - Here, the International Myeloma Working Group (IMWG) updates its clinical practice recommendations for the management of multiple myeloma-related renal impairment on the basis of data published until Dec 31, 2022. All patients with multiple myeloma and renal impairment should have serum creatinine, estimated glomerular filtration rate, and free light chains (FLCs) measurements together with 24-h urine total protein, electrophoresis, and immunofixation. If non-selective proteinuria (mainly albuminuria) or involved serum FLCs value less than 500 mg/L is detected, then a renal biopsy is needed. The IMWG criteria for the definition of renal response should be used. Supportive care and high-dose dexamethasone are required for all patients with myeloma-induced renal impairment. Mechanical approaches do not increase overall survival. Bortezomib-based regimens are the cornerstone of the management of patients with multiple myeloma and renal impairment at diagnosis. New quadruplet and triplet combinations, including proteasome inhibitors, immunomodulatory drugs, and anti-CD38 monoclonal antibodies, improve renal and survival outcomes in both newly diagnosed patients and those with relapsed or refractory disease. Conjugated antibodies, chimeric antigen receptor T-cells, and T-cell engagers are well tolerated and effective in patients with moderate renal impairment.
AB - Here, the International Myeloma Working Group (IMWG) updates its clinical practice recommendations for the management of multiple myeloma-related renal impairment on the basis of data published until Dec 31, 2022. All patients with multiple myeloma and renal impairment should have serum creatinine, estimated glomerular filtration rate, and free light chains (FLCs) measurements together with 24-h urine total protein, electrophoresis, and immunofixation. If non-selective proteinuria (mainly albuminuria) or involved serum FLCs value less than 500 mg/L is detected, then a renal biopsy is needed. The IMWG criteria for the definition of renal response should be used. Supportive care and high-dose dexamethasone are required for all patients with myeloma-induced renal impairment. Mechanical approaches do not increase overall survival. Bortezomib-based regimens are the cornerstone of the management of patients with multiple myeloma and renal impairment at diagnosis. New quadruplet and triplet combinations, including proteasome inhibitors, immunomodulatory drugs, and anti-CD38 monoclonal antibodies, improve renal and survival outcomes in both newly diagnosed patients and those with relapsed or refractory disease. Conjugated antibodies, chimeric antigen receptor T-cells, and T-cell engagers are well tolerated and effective in patients with moderate renal impairment.
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U2 - 10.1016/S1470-2045(23)00223-1
DO - 10.1016/S1470-2045(23)00223-1
M3 - Review article
C2 - 37414019
AN - SCOPUS:85164264504
SN - 1470-2045
VL - 24
SP - e293-e311
JO - The Lancet Oncology
JF - The Lancet Oncology
IS - 7
ER -