Role of plasma exchange in the treatment of myeloma nephropathy: experience of one institution and systematic review.

Plasmapheresis is an efficient method of removing light chains from the circulation. Several studies have shown that it improves renal function in patients with multiple myeloma and renal impairment due to cast nephropathy. The degree of renal failure has been shown to be an important predictor of morbidity and mortality in myeloma. The use of plasmapheresis remains controversial, since it does not affect plasma cells and thus further production of light chains. In addition, existing evidence does not demonstrate a clear benefit from plasmapheresis in these patients. However, data, including some of the new targeted therapies for myeloma, are lacking. Herein, we present our institution's experience in the use of plasmapheresis in patients with myeloma and renal failure, and review the existing literature.