“Kidney failure is a serious complication of multiple myeloma, and up to 50% of patients with this most frequent haematological malignancy may develop some form of renal impairment…”
You’ve been diagnosed with multiple myeloma. At the same time, if your creatinine, BUN and/or GFR levels are out of the normal range, please read the studies linked below to learn about the interaction of MM, MM treatment and both of those when compared to renal/kidney health.
Kidney/renal damage for newly diagnosed multiple myeloma patients can be as dangerous as the MM itself.
It is the job of your oncologist to focus on your cancer- your MM. That makes perfect sense. However, according to the studies linked below, the health of your kidneys is intertwined with your MM (light chains) as well as the therapies designed to treat your MM such as
If your oncologist focuses on treating your MM at the expense of your kidney health, you could become a statistic below and die “while in remission” yet your cause of death could be “related to factors that may be associated with MM or its treatment.”
Yes, you must focus on your incurable blood cancer, multiple myeloma. At the same time, you have to keep one eye on those therapies listed above that can damage your kidney health. Lastly, consider those evidence-based but non-toxic therapies that research shows can protect or even health your kidneys.
The bottom line is that if you have been diagnosed with MM and your kidney health is damaged in any way, you should consider SOC mm therapies as well as non-conventional therapies that may be able to heal and/or protect your kidney health.
As always, if you have any questions or comments about the issues discussed in this blog post, don’t hesitate to ask a question or make a comment. I will reply to you ASAP.
Thank you for your time and attention. Hang in there,
David Emerson
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
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“We report here six cases of renal failure secondary to MM treated with bortezomib. All patients had poor performance status of 3-4 on ECOG scale. Five out of six patients showed satisfactory anti-myeloma response to bortezomib.
Reversal of renal failure was observed in all six patients. Adverse effects to bortezomib were mild and manageable.
Reversal of renal failure persisted despite incomplete response to MM in two cases, and progression of disease in one patient. It appears that bortezomib may have an effect on the kidneys in reversal of renal failure, other than its anti-myeloma effect. In conclusion, bortezomib appears to be an effective treatment for patients with advanced MM and renal failure irrespective of performance status and age…”
“3.4. Cause of death-
For two‐thirds (67%) of patients, death was primarily attributed to disease progression (which was defined as symptomatic relapse, increases in M‐protein or free light chain levels) (Figure A). Among those whose death was attributed to disease progression, 44% also had other causes listed. These were primarily renal failure (59%) and infection (28%)…
…Across treatment lines, deaths were often not solely due to disease progression (Figure B). Factors such as renal failure and infection also played a role (in 30% and 20% of patients at 1L, respectively)…
…For the group of patients who died while in remission (12%), deaths were still related to factors that may be associated with MM or its treatment, including disease progression (10%), renal failure (15%) or infection (22%) (Figure C)…
…Nevertheless, other causes of death that may be related to MM and associated treatment were also important, such as renal failure (30%) and infection (20%), particularly at early treatment lines. The proportion of deaths due to disease progression increased at later lines, but renal failure and infections remained significant contributors to cause of death.
“Renal failure is a serious complication of multiple myeloma, and up to 50% of patients with this most frequent haematological malignancy may develop some form of renal impairment.
The aetiology of renal damage is multifactorial, but increased production of free light chains that are filtered into the urine is crucial for the development of renal failure and could be associated with distal tubule involvement
(myeloma kidney, light chain cast nephropathy) or with fully developed Fanconi syndrome in proximal tubule damage (proximal tubulopathy, light chain proximal tubulopathy).
Glomerular damage most often manifests as AL amyloidosis or light chain deposition disease; both cause severe nephrotic syndrome.
Early and adequate chemotherapy in association with symptomatic treatment can lead to rapid reduction of serum light chain concentration which is necessary to prevent development of renal failure.
At present, effective therapeutic procedures can be used for this purpose, where especially a triple combination of treatment containing one of the proteasome inhibitors (bortezomib, carfilzomib or ixazomib) is able to elicit a haematological response within a few days.
If there is a good haematological response to treatment, up to 50% of patients with renal failure will restore their renal function…
Renal function repair can be accelerated by removing light chains from serum by dialysis with high-cutoff membrane (HCO-HD). Using this procedure can increase the chance of dialysis independence in more than 60% of patients with renal failure.
Data from previously published studies on HCO-HD (MYRE or EuLITE study) have not yielded as optimistic results as originally expected, however, HCO-HD could be beneficial for some subgroup of patients with renal failure in myeloma kidney.
Despite the fact that overall prognosis and survival of patients with multiple myeloma have dramatically improved, the condition with renal failure in these patients remains serious.”
“There is no difference in efficacy between triplet vs doublet bortezomib-based therapies to treat patients with initial myeloma cast nephropathy and acute kidney injury without a dialysis requirement, according to research published in the Journal of Clinical Oncology.
Frank Bridoux, MD, PhD, and colleagues in the MYRE study group conducted a multicenter controlled trial to compare the tolerance profile and renal recovery of doublet therapy, which consisted of bortezomib with dexamethasone (BD), and the triplet combination, which was cyclophosphamide with BD (C-BD).
…Following 3 cycles with BD or C-BD, patients who experienced a less than 50% reduction in serum free light chains (sFLCs) received treatment with cyclophosphamide (BD arm) or thalidomide (C-BD arm).
The primary study endpoint was renal response at 3 months. Renal response was characterized as a serum creatinine level ≤170 mmol/L and/or an estimated glomerular filtration rate ≥40 mL/min/1.73 m2or higher.
Very good partial response (VGPR) was defined as a reduction in sFLCs of 90% or more. At 3 months, VGPR or better was seen in 39.1% of patients given BD and 51.1% of patients given C-BD (RR, 0.76; P=.14). A level of sFLCs of ≤500 mg/L was demonstrated after 1 cycle of treatment for 75.0% of patients given BD and 72.8% of patients given C-BD…
The study investigators concluded that C-BD did not confer a benefit over BD in renal recovery for the patient population in this study. However, they also suggested the choice of doublet or triplet bortezomib-based therapy may be based on a patient’s fitness.
Reference
Bridoux F, Arnulf B, Karlin L, et al. Randomized trial comparing double versus triple bortezomib-based regimen in patients with multiple myeloma and acute kidney injury due to cast nephropathy [published online June 23, 2020]. J Clin Oncol. doi: 10.1200/JCO.20.00298
