How is multiple myeloma treated in patients with renal impairment?

Updated: Aug 14, 2019
  • Author: Sara J Grethlein, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

Answer

Concerns in the treatment of patients with multiple myeloma include renal impairment, thrombosis, infection, and skeletal events.

Renal impairment

Considerations are as follows:

  • The treatment of patients with renal impairment from myeloma can be daunting due to concerns about clearance of drugs and further injury from treatment or diagnostic studies. Proteasome inhibitors are the preferred choice due to their safety profile in renal failure. 

  • A working group consensus statement has clarified that autologous transplantation is not absolutely contraindicated in patients with renal impairment, but it should be reserved for younger patients with chemosensitive disease [51]

  • Because of the common occurrence of renal involvement in myeloma, the use of nephrotoxic agents—most notably, nonsteroidal anti-inflammatory drugs (NSAIDs) and IV contrast agents—should be minimized or avoided


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