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International Myeloma Working Group Recommendations for the Diagnosis and Management of Myeloma-Related Renal Impairment.

Publication ,  Journal Article
Dimopoulos, MA; Sonneveld, P; Leung, N; Merlini, G; Ludwig, H; Kastritis, E; Goldschmidt, H; Joshua, D; Orlowski, RZ; Powles, R; Vesole, DH ...
Published in: J Clin Oncol
May 1, 2016

PURPOSE: The aim of the International Myeloma Working Group was to develop practical recommendations for the diagnosis and management of multiple myeloma-related renal impairment (RI). METHODS: Recommendations were based on published data through December 2015, and were developed using the system developed by the Grading of Recommendation, Assessment, Development, and Evaluation Working Group. RECOMMENDATIONS: 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, if available, and urine electrophoresis of a sample from a 24-hour urine collection (grade A). The Chronic Kidney Disease Epidemiology Collaboration, preferably, or the Modification of Diet in Renal Disease formula should be used for the evaluation of estimated glomerular filtration rate in patients with stabilized serum creatinine (grade A). International Myeloma Working Group criteria for renal reversibility should be used (grade B). For the management of RI in patients with multiple myeloma, high fluid intake is indicated along with antimyeloma therapy (grade B). The use of high-cutoff hemodialysis membranes in combination with antimyeloma therapy can be considered (grade B). Bortezomib-based regimens remain the cornerstone of the management of myeloma-related RI (grade A). High-dose dexamethasone should be administered at least for the first month of therapy (grade B). Thalidomide is effective in patients with myeloma with RI, and no dose modifications are needed (grade B). Lenalidomide is effective and safe, mainly in patients with mild to moderate RI (grade B); for patients with severe RI or on dialysis, lenalidomide should be given with close monitoring for hematologic toxicity (grade B) with dose reduction as needed. High-dose therapy with autologous stem cell transplantation (with melphalan 100 mg/m(2) to 140 mg/m(2)) is feasible in patients with RI (grade C). Carfilzomib can be safely administered to patients with creatinine clearance > 15 mL/min, whereas ixazomib in combination with lenalidomide and dexamethasone can be safely administered to patients with creatinine clearance > 30 mL/min (grade A).

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Published In

J Clin Oncol

DOI

EISSN

1527-7755

Publication Date

May 1, 2016

Volume

34

Issue

13

Start / End Page

1544 / 1557

Location

United States

Related Subject Headings

  • Renal Insufficiency
  • Oncology & Carcinogenesis
  • Multiple Myeloma
  • Humans
  • 3211 Oncology and carcinogenesis
  • 1112 Oncology and Carcinogenesis
  • 1103 Clinical Sciences
 

Citation

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Dimopoulos, M. A., Sonneveld, P., Leung, N., Merlini, G., Ludwig, H., Kastritis, E., … Terpos, E. (2016). International Myeloma Working Group Recommendations for the Diagnosis and Management of Myeloma-Related Renal Impairment. J Clin Oncol, 34(13), 1544–1557. https://doi.org/10.1200/JCO.2015.65.0044
Dimopoulos, Meletios A., Pieter Sonneveld, Nelson Leung, Giampaolo Merlini, Heinz Ludwig, Efstathios Kastritis, Hartmut Goldschmidt, et al. “International Myeloma Working Group Recommendations for the Diagnosis and Management of Myeloma-Related Renal Impairment.J Clin Oncol 34, no. 13 (May 1, 2016): 1544–57. https://doi.org/10.1200/JCO.2015.65.0044.
Dimopoulos MA, Sonneveld P, Leung N, Merlini G, Ludwig H, Kastritis E, et al. International Myeloma Working Group Recommendations for the Diagnosis and Management of Myeloma-Related Renal Impairment. J Clin Oncol. 2016 May 1;34(13):1544–57.
Dimopoulos, Meletios A., et al. “International Myeloma Working Group Recommendations for the Diagnosis and Management of Myeloma-Related Renal Impairment.J Clin Oncol, vol. 34, no. 13, May 2016, pp. 1544–57. Pubmed, doi:10.1200/JCO.2015.65.0044.
Dimopoulos MA, Sonneveld P, Leung N, Merlini G, Ludwig H, Kastritis E, Goldschmidt H, Joshua D, Orlowski RZ, Powles R, Vesole DH, Garderet L, Einsele H, Palumbo A, Cavo M, Richardson PG, Moreau P, San Miguel J, Rajkumar SV, Durie BGM, Terpos E. International Myeloma Working Group Recommendations for the Diagnosis and Management of Myeloma-Related Renal Impairment. J Clin Oncol. 2016 May 1;34(13):1544–1557.

Published In

J Clin Oncol

DOI

EISSN

1527-7755

Publication Date

May 1, 2016

Volume

34

Issue

13

Start / End Page

1544 / 1557

Location

United States

Related Subject Headings

  • Renal Insufficiency
  • Oncology & Carcinogenesis
  • Multiple Myeloma
  • Humans
  • 3211 Oncology and carcinogenesis
  • 1112 Oncology and Carcinogenesis
  • 1103 Clinical Sciences