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Multiple Myeloma an incurable disease, but I have spent the last 25 years in remission using a blend of conventional oncology and evidence-based nutrition, supplementation, and lifestyle therapies from peer-reviewed studies that your oncologist probably hasn't told you about.
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Healing Kidneys in Multiple Myeloma
According to research 40%-60% of myeloma patients present with kidney involvement upon diagnosis. Healing kidneys in multiple myeloma is essential to say the least.
As the video below explains, determining the exact cause of renal impairment can be a challenge for the newly diagnosed MM patients.
Causes & management of renal impairment in patients with multiple myeloma
What therapies, both conventional and non-conventional, have been shown to enhance kidney function for newly diagnosed myeloma patients who present with kidney involvement?
For newly diagnosed multiple myeloma (MM) patients with kidney involvement (myeloma kidney, cast nephropathy, or other renal complications), therapies aim to reduce the burden of light chains on the kidneys, improve renal function, and slow disease progression. The most effective strategies include conventional treatments targeting myeloma itself, as well as supportive therapies and complementary approaches to enhance kidney function.
Conventional Therapies
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Rapid Myeloma Treatment (Anti-Myeloma Therapy)
- Proteasome Inhibitors (PIs): Bortezomib (Velcade) is the first-line agent due to its rapid action in reducing free light chains.
- Immunomodulatory Drugs (IMiDs): Lenalidomide is used but requires dose adjustments in renal impairment.
- Monoclonal Antibodies: Daratumumab (anti-CD38) and Isatuximab are often combined with PIs and steroids to enhance response.
- High-Dose Steroids: Dexamethasone reduces inflammation and light chain production.
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Plasmapheresis or High-Cutoff Hemodialysis
- Helps remove circulating free light chains in severe kidney failure, though its effectiveness is debated.
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Supportive Care for Kidney Protection
- Aggressive Hydration: Prevents tubular damage and promotes clearance of toxic light chains.
- Avoid Nephrotoxic Medications: NSAIDs, contrast dyes, and some antibiotics should be minimized.
- Correction of Hypercalcemia: Bisphosphonates (e.g., zoledronic acid) or denosumab may help control calcium levels.
Non-Conventional & Adjunct Therapies
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Nutritional Interventions
- Low-Protein, Plant-Based Diet: Reduces kidney workload while ensuring adequate nutrition.
- Alkaline Diet: Some evidence suggests it may reduce metabolic acidosis and kidney stress.
- Omega-3 Fatty Acids: May have anti-inflammatory and nephroprotective effects.
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Herbal & Natural Supplements (Use with Caution)
- Astragalus: May have nephroprotective properties, but clinical evidence is limited.
- Curcumin: Anti-inflammatory effects may help, but interactions with MM drugs need to be considered.
- Resveratrol: Has been studied for anti-cancer and kidney protection properties.
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Acupuncture & Traditional Chinese Medicine (TCM)
- Some studies suggest acupuncture may support kidney function and reduce inflammation, but data is limited.
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Mind-Body Practices
- Yoga & Meditation: Help manage stress and inflammation.
- Exercise: Low-impact exercise improves circulation and overall kidney health.
Key Considerations
- Early diagnosis and rapid intervention are critical for kidney recovery.
- Close monitoring of kidney function (eGFR, creatinine, urine albumin, light chains).
- Integrative approaches should always be discussed with a medical team to avoid interactions with myeloma treatments.
As the therapies for kidney involvement listed above demonstrate, there are both conventional (FDA approved) and non-conventional therapies shown to enhance kidney function.
As a long-term MM survivor who has benefited from non-conventional therapies I have to say that both conventional and non-conventional kidney therapies must be considered in the case of MM patients with kidney involvement.
Email me at David.PeopleBeatingCancer@gmail.com with questions about kidney involvement and your MM.
Good luck,
David Emerson
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
High cutoff versus high-flux haemodialysis for myeloma cast nephropathy in patients receiving bortezomib-based chemotherapy (EuLITE): a phase 2 randomised controlled trial
Background
In multiple myeloma, severe acute kidney injury due to myeloma cast nephropathy is caused by pathogenic free light chain immunoglobulin in serum. High cutoff haemodialysis (HCO-HD) can remove large quantities of free light chain immunoglobulin from serum, but its effect on clinical outcomes is uncertain. We therefore aimed to assess whether HCO-HD could increase the frequency of renal recovery in patients with de novo multiple myeloma, severe acute kidney injury, and myeloma cast nephropathy relative to treatment with standard high-flux haemodialysis (HF-HD).
In this open-label, phase 2, multicentre, randomised controlled trial (EuLITE), we recruited patients with newly diagnosed multiple myeloma, biopsy-confirmed cast nephropathy, and acute kidney injury that required dialysis from renal services in 16 hospitals in the UK and Germany.
Patients were randomly assigned (1:1) by random number generation to receive intensive HCO-HD (in sessions lasting 6–8 h) or standard HF-HD and they were stratified by age and centre. Patients and the medical staff treating them were not masked to treatment allocation.
Patients received bortezomib, doxorubicin, and dexamethasone chemotherapy, and were then followed up for 2 years. The primary outcome was independence from dialysis at 90 days after random allocation to groups, which was assessed in an intention-to-treat population. The trial has completed follow-up, and is registered at the ISRCTN registry, number ISRCTN45967602.
Between June 7, 2008, and Sept 18, 2013, we recruited 90 patients, of whom 43 (48%) were randomly assigned to receive HCO-HD and 47 (52%) were randomly assigned to receive HF-HD.
All 90 patients were included in the analysis of the primary outcome. One (2%) patient from the HF-HD group withdrew consent before receiving treatment. During treatment, nine (21%) patients from the HCO-HD group and two (4%) patients in the HF-HD group discontinued trial treatment.
After 90 days, 24 (56%) patients in the HCO-HD group and 24 (51%) patients in the HF-HD group were independent from dialysis (relative risk 1·09, 95% CI 0·74–1·61; p=0·81).
During the 2-year follow-up, 98 serious adverse events were reported in the HCO-HD group and 82 serious adverse events were reported in the HF-HD group. The most common serious adverse events were infections and adverse events related to the cardiovascular and thrombotic and musculoskeletal systems.
During the first 90 days, 26 infections were reported in the HCO-HD group and 13 infections were reported in the HF-HD group, including 14 lung infections in the HCO-HD group and three lung infections in the HF-HD group.
In this phase 2 study, HCO-HD did not improve clinical outcomes for patients with de novo multiple myeloma and myeloma cast nephropathy who required haemodialysis for acute kidney injury and who received a bortezomib-based chemotherapy regimen relative to those receiving HF-HD. These results do not support proceeding to a phase 3 study for HCO-HD in these patients.
Healing kidneys in multiple myeloma Healing kidneys in multiple myeloma Healing kidneys in multiple myeloma