International Myeloma working group recommendations for the diagnosis and management of Myeloma-Related Renal Impairment

Meletios A. Dimopoulos, Pieter Sonneveld, Nelson Leung, Giampaolo Merlini, Heinz Ludwig, Efstathios Kastritis, Hartmut Goldschmidt, Douglas Joshua, Robert Z. Orlowski, Raymond Powles, David H. Vesole, Laurent Garderet, Hermann Einsele, Antonio Palumbo, Michele Cavo, Paul G. Richardson, Philippe Moreau, Jeśus San Miguel, S. Vincent Rajkumar, Brian G.M. DurieEvangelos Terpos

Research output: Contribution to journalArticlepeer-review

150 Scopus citations

Abstract

Purpose The aim of the International Myeloma Working Group was to develop practical recommendations for the diagnosis and management of multiple myeloma-related renal impairment (RI). Methods Recommendations were based on published data through December 2015, and were developed using the system developed by the Grading of Recommendation, Assessment, Development, and Evaluation Working Group. Recommendations All patients with myeloma at diagnosis and at disease assessment should have serum creatinine, estimated glomerular filtration rate, and electrolytes measurements as well as free light chain, if available, and urine electrophoresis of a sample from a 24-hour urine collection (grade A). The Chronic Kidney Disease Epidemiology Collaboration, preferably, or the Modification of Diet in Renal Disease formula should be used for the evaluation of estimated glomerular filtration rate in patients with stabilized serum creatinine (grade A). International Myeloma Working Group criteria for renal reversibility should be used (grade B). For themanagement of RI in patientswithmultiplemyeloma, high fluid intake is indicated along with antimyeloma therapy (grade B). The use of high-cutoff hemodialysis membranes in combination with antimyeloma therapy can be considered (grade B). Bortezomib-based regimens remain the cornerstone of the management of myeloma-related RI (grade A). High-dose dexamethasone should be administered at least for the first month of therapy (grade B). Thalidomide is effective in patients with myeloma with RI, and no dose modifications are needed (grade B). Lenalidomide is effective and safe, mainly in patients with mild to moderate RI (grade B); for patients with severe RI or on dialysis, lenalidomide should be given with closemonitoring for hematologic toxicity (grade B) with dose reduction as needed. High-dose therapy with autologous stem cell transplantation (with melphalan 100 mg/m2 to 140 mg/m2) is feasible in patients with RI (grade C). Carfilzomib can be safely administered to patients with creatinine clearance . 15 mL/min, whereas ixazomib in combination with lenalidomide and dexamethasone can be safely administered to patients with creatinine clearance . 30 mL/min (grade A).

Original languageEnglish (US)
Pages (from-to)1544-1557
Number of pages14
JournalJournal of Clinical Oncology
Volume34
Issue number13
DOIs
StatePublished - May 1 2016

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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