New Recommendations Issued for the Diagnosis, Management of Myeloma-related Renal Impairment

The International Myeloma Working Group developed practical recommendations for the diagnosis and management of multiple myeloma-related renal impairment.¹

The group based its recommendations on published data through December 2015, and they were created using the system developed by the Grading of Recommendation, Assessment, Development, and Evaluation Working Group.

Grade A recommendations included:

• All patients with myeloma at diagnosis and at disease assessment should have serum creatinine, estimated glomerular filtration rate, and electrolytes measurements as well as free light chain, and urine electrophoresis of a sample from 24-hour urine collection.
• Estimated glomerular filtration rate in patients with stabilized serum creatinine should be evaluated using the Chronic Kidney Disease Epidemiology Collaboration or the Modification of Diet in Renal Disease formula.
• Bortezomib-based regimens remain the cornerstone of the management of myeloma-related renal impairment.
• In patients with creatinine clearance > 15 mL/min, carfilzomib can be safely administered.
• In patients with creatinine clearance > 30 mL/min, lenalidomide and dexamethasone can be safely administered.

Grade B recommendations included:

• High fluid intake along with antimyeloma therapy is indicated
• High-cutoff hemodialysis membranes along with antimyeloma therapy can be considered
• High-dose dexamethasone should be administered at least for the first month of therapy.
• Thalidomide is effective in patients with myeloma and renal impairment and no dose modifications are required.
• For patients with mild-to-moderate renal impairment, lenalidomide is generally safe and effective.
• For patients with severe renal impairment or those who are on dialysis, lenalidomide should be administered with close monitoring for hematologic toxicity; doses can be reduced as needed.

Grade C recommendations included:

• High-dose therapy with autologous stem cell transplantation is feasible.

Reference

1. Dimopoulos MA, Sonneveld P, Leung N, et al. International Myeloma Working Group recommendations for the diagnosis and management of myeloma-related renal impairment [published online ahead of print March 14, 2016]. J Clin Oncol. doi: 10.1200/JCO.2015.65.0044.