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- W82796275 abstract "To the Editor: Burnette et al. (June 16 issue)1 evaluated bortezomib-based chemotherapy and plasma exchange for the management of myeloma kidney. The reported renal recovery rate of 86% will probably lead to improved patient survival. However, interpretation of these results should be approached with caution. The authors’ principal finding confirmed that of a previous study showing that an early reduction in concentrations of serum free light chains is associated with renal recovery.2 The authors did not show the relative contribution of plasma exchange to the achievement of this reduction. Previous studies have shown the inability of plasma exchange to provide a meaningful magnitude of free light-chain removal, as compared with extended high-cutoff hemodialysis.3 In addition, the only large controlled trial of plasma exchange involving these patients did not show a clinical benefit.4 Therefore, the early reduction of levels of free light chains probably represents the efficacy of the chemotherapy rather than the plasma exchange. Controlled studies assessing the additional benefit of plasma exchange beyond effective chemotherapy, similar to the ongoing trials EULITE (European Trial of Free Light Chain Removal by Extended Haemodialysis in Cast Nephropathy; Current Controlled Trials number, ISRCTN45967602) and MYRE (Studies in Patients with Multiple Myeloma and Renal Failure Due to Myeloma Cast Nephropathy; ClinicalTrials.gov number, NCT01208818) assessing extended hemodialysis, are warranted before any clinical recommendations can be made." @default.
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- W82796275 date "2011-09-15" @default.
- W82796275 modified "2023-09-24" @default.
- W82796275 title "Renal Improvement in Myeloma with Plasma Exchange" @default.
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- W82796275 doi "https://doi.org/10.1056/nejmc1108282#sa1" @default.
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