How is multiple myeloma treated in patients with renal impairment?

Updated: Dec 31, 2018
  • 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

  • In patients with case nephropathy, the combination of bortezomib and high-dose dexamethasone is the preferred therapy

  • 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 [43]

  • 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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