Theralite and multiple myeloma - do we know the answer regarding treatment efficacy of a nephrologist with a haematologist?
Abstract
Multiple myeloma with overproduction of monoclonal free light chains (FLC) leads to renal failure in 20-40% of cases and 10% of these require dialysis treatment. Over the past 10 years, Theralite has been used in this setting - a dialyzer with a high cut-off (HCO) membrane, which decreases FLC levels by 70-90% during haemodialysis (HD).
If the haematological treatment if also effective, renal function may recover. Our cohort treated between 2012 and 2018 consisted of 37 patients with a median number of 8 HD using a HCO membrane (HCO-HD) per patient, and only 1 patient died during this treatment.
There were 24 patients (65%) without the need for dialysis after 3 months ("successful group"), who had a median of 7 HCO-HD/patient. Thirteen patients ("unsuccessful group") continued with dialysis and had a median of 10 HCO-HD/patient.
We further followed patients treated between 2012-2018 and found that while in the successful group only 5 patients died (21% mortality), there were 9 deaths recorded in 13 patients of the unsuccessful group (69% mortality). It has been shown that measuring FLC levels before and after each HCO-HD is useful for estimating patient prognosis, as treatment effectiveness may be anticipated from the graph.
Recovery of dialysis-independent renal function is associated with improved overall survival. Close collaboration between nephrologists and haematologists who manage myeloma chemotherapy is necessary.